Modified frontalis suspension technique with review of large series

To describe and report results of a modified frontalis suspension technique utilizing direct fixation to tarsus, lash margin rotation, eyelid crease fixation, conservative blepharoplasty, and rhomboidal configuration.

A retrospective chart review of frontalis suspension patients over a 28-year period was performed.

Data from 171 eyelids in 93 patients were reviewed. Ages ranged from 1 to 84 years with a median age of 16. The indications for surgery included the following: congenital ptosis in 107 eyelids (62.6%), chronic progressive external ophthalmoplegia in 17 (9.9%), jaw winking ptosis in 14 (8.2%), blepharophimosis in 12 (7.0%), cranial nerve III palsy in 10 (5.8%), traumatic ptosis in 9 (5.3%), and myasthenia in 2 (1.2%). Autogenous fascia lata was utilized in 156 lids (91.3%), while silicone rods or banked fascia was used in 11 (6.4%) and 4 (2.3%) lids, respectively.Average follow up was 11.7 months (range 2 to 108 months). An excellent result was defined as ≤1 mm asymmetry in primary gaze and an eyelid position of 2.5 mm or less below the superior limbus. Eighty-nine of 93 patients (95.7%) achieved excellent results. Six lids in 4 patients (3.5%) were undercorrected. No patients were overcorrected. Only 2 patients with autogenous fascia lata (3.4%) required a secondary bilateral frontalis suspension at the 2- and 3-year time intervals.

The authors believe that technique modifications including direct eyelid crease incision and tarsal fixation, conservative fat removal blepharoplasty even in children, lash margin rotation, and rhomboidal configuration with single midline brow incision give improved results of frontalis suspension when compared with conventional techniques.