Suture Traction Maneuver to Minimize Hemorrhage in Müller Muscle-Conjunctival Resection: One Minute Technique

Introduction: Müller muscle-conjunctival resection (MMCR) is a widely adopted procedure for the correction of mild-to-moderate ptosis. Although technically straightforward and effective, intraoperative and postoperative hemorrhage remains a notable complication, particularly during the early learning curve. This study describes a simple traction-suture maneuver designed to minimize hemorrhage following MMCR. Surgical Technique: A retrospective review was performed of 23 patients (12 women, 11 men; mean age: 50.0±14.4 y) who underwent MMCR with the adjunctive traction-suture technique. Following conjunctiva-Müller muscle excision, a 6-0 polypropylene suture was gently tensioned for ∼1 minute to compress the resection bed before being tied over a bolster. A bandage contact lens was placed, and both the suture and lens were removed on postoperative day 10. Results: The mean amount of tissue resection was 8.4±0.6 mm, with a mean follow-up of 4.0±2.6 months. The average postoperative improvement in margin reflex distance 1 (MRD1) was 2.2 mm, with all patients achieving adequate eyelid elevation and complete clearance of the visual axis. No intraoperative or postoperative complications were observed, including hemorrhage, exposure keratopathy, or suture-related problems. None of the patients required revision surgery or experienced recurrence during follow-up. Conclusions: The addition of a 1-minute traction-suture step during MMCR may provide effective intraoperative tamponade, mitigating the risk of delayed hemorrhage without adding complexity to the procedure. This simple and reproducible maneuver represents a potential refinement to enhance the safety and predictability of MMCR.