Background/Objectives: Ptosis surgery corrects drooping upper eyelids, improving function and esthetics. Traditional methods like marginal reflex distance (MRD) and palpebral fissure height (PFH) offer limited one-dimensional measurements. This study evaluates AI-based corneal exposure ratio (CER) analysis, a two-dimensional approach, compared to manual ImageJ methods for assessing ptosis surgery outcomes. Methods: In this prospective study, 100 eyes from 50 patients were analyzed using both methods. AI-based CER measurements were compared to manual ImageJ measurements for reliability and accuracy. Results: AI-based CER measurements were comparable to manual ImageJ, with high reliability (ICC 0.992, 0.985). Preoperative CER was 55.34% (manual) and 55.79% (AI), increasing to 75.92% (manual) and 75.84% (AI) postoperatively. The AI tool showed minimal bias and high repeatability (ICC 1.000), offering faster automated measurements. Conclusions: AI-based CER analysis matched manual methods in accuracy but provided significant efficiency advantages, making it suitable for clinical use. Limitations include a small homogeneous sample size and reliance on 2D imaging, which may not fully capture three-dimensional changes. Further studies are recommended to enhance generalizability and precision.

Reconstructing coccygeal defects can be challenging because stable coverage must be achieved while preserving the natural contour of the gluteal region. Successful reconstruction requires not only durable coverage but also adequate restoration of soft-tissue volume and gluteal contour. A 29-year-old woman developed a full-thickness burn with exposed bone in the coccygeal region after prolonged contact with an electric heating pad. Initial treatment with split-thickness skin grafting resulted in partial graft loss and persistent necrosis. To optimize the wound bed, serial debridement and negative-pressure wound therapy were performed. Despite adequate preparation, a 12×12 cm defect with a maximal depth of approximately 2 cm and clinically relevant three-dimensional dead space remained. A muscle-sparing latissimus dorsi (msLD) free flap was used for definitive reconstruction. The limited muscle component was used to obliterate the dead space, while the flap was contoured to restore soft-tissue volume. The postoperative course was uneventful, with stable flap coverage and maintained gluteal contour. This case demonstrates that an msLD free flap can provide durable coverage, dead-space obliteration, and contour restoration in an extensive coccygeal defect.