During clinical visits, we often encounter many questions from parents of children with ptosis. The main concern is to improve the appearance, hoping to achieve complete symmetry of the eyes, and some parents cannot accept the delayed fall of the upper eyelid and the inability to close the eyelid after surgery. Little do we know that the same ptosis, which looks similar in appearance, varies from patient to patient. An important factor in determining this is the strength of the levator muscle. The levator muscle is the muscle that performs the function of lifting the eyelid in the normal physiological state, and in normal people the strength of the levator muscle is usually above 10mm. In children with ptosis, the strength of the levator muscle is reduced to varying degrees, and in some severe cases, the levator muscle is completely weak. It is now common practice to use 4mm of levator muscle strength as the threshold for selecting a surgical procedure. For those below 4mm, a suspension using frontalis muscle strength is chosen, while those above 4mm may opt for the levator augmentation procedure (usually levator shortening). The postoperative appearance is different depending on the surgical approach. Although both options can lift the upper lid into place, there is a significant difference in post-operative upper lid mobility. The levator augmentation procedure is more in line with normal physiology, and the patient will have a more natural looking lid with better upper lid mobility. However, patients with the frontal flap suspension style will have more pronounced eyelid failure to close and will have the appearance of open eyes during nighttime sleep, requiring extensive eye ointment application that will last for more than six months. Also, patients have poor upper lid mobility, which does not come down when lifted, often exposing the upper edge of the cornea when gazing downward, and appearing larger in appearance than normal eyes. Therefore, if the patient has poor upper eyelid muscle strength and can only have a frontal flap suspension, the parents must be able to accept the above and cannot hope that it will come out as normal. In addition, there is often a difference in postoperative satisfaction between patients with ptosis in both eyes and those with ptosis in one eye. If both eyes have ptosis, the patient’s satisfaction is often higher after surgery using the same surgical approach, while parents of children with monocular ptosis often compare the operated eye to the normal eye and are dissatisfied with the surgery in one way or another. As always, even if done perfectly, it can only make the affected eye as close to the normal eye as possible and can never be exactly the same as the normal eye, especially in patients with severe ptosis who need to undergo the frontalis flap procedure. We would like to remind parents that the first prerequisite for ptosis surgery is to prevent weakness in the affected eye, especially in young children, and to try to improve the appearance, as there may be changes during the long growth phase, so you cannot hope to achieve this in one step. In young children with ptosis, it is advisable to have blepharoplasty (double eyelid) surgery on the healthy eye at or near the adult stage, as early surgery on both eyes is likely to have a different shape. In young children with ptosis, the height of the eyelid cannot be adjusted during surgery, but can only be shortened according to the preoperative examination and adjusted during surgery according to the condition of the levator aponeurosis and the position of the upper eyelid during surgery. 4. Some patients with poor muscle strength (around 4mm) may have undercorrection (i.e., smaller eyes) after long term observation of the levator muscle shortening and need to be prepared to have another surgery.