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Updated: Feb 11, 2026
Engineered Vascularized Muscle Flap
Published on: January 11, 2016
Frontalis Muscle Flap Versus Maximal Anterior Levator Resection as First Option for Patients With Severe Congenital
Ramón Medel1, Salvador Molina1, Luz Maria Vasquez1
1Ophthalmic Plastic Surgery Department.
Insights
Frontalis muscle flap surgery required fewer reoperations than maximal anterior levator resection for congenital ptosis in young children. Both techniques offered good long-term results, but frontalis flap surgery provided a better outcome without residual ptosis.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Reconstructive Surgery
Background:
- Congenital ptosis significantly impacts vision and aesthetics in young children.
- Poor levator function presents a surgical challenge in congenital ptosis correction.
- Evaluating long-term outcomes of different surgical techniques is crucial for pediatric ophthalmology.
Purpose of the Study:
- To compare frontalis muscle flap (FMF) and maximal anterior levator resection (ALR) as primary surgical treatments for congenital ptosis.
- To assess functional and aesthetic outcomes over a 10-year follow-up period in patients under two years old.
- To determine the need for reoperations and evaluate complications associated with each technique.
Main Methods:
- Retrospective analysis of 58 patients (71 eyelids) with severe ptosis and poor levator function.
- Surgical groups: frontalis muscle flap (n=47) and maximal anterior levator resection (n=24).
- Eyelid measurements, complication rates, reoperation needs, and palpebral contour were assessed at baseline and 1, 5, and 10 years post-surgery.
Main Results:
- Both FMF and ALR achieved stable margin-reflex distance over 10 years, with no significant difference in initial palpebral height correction.
- Frontalis muscle flap required significantly fewer reoperations (23%) compared to maximal anterior levator resection (50%).
- Eyelid contour alterations were observed in 13% of FMF cases and 21% of ALR cases; 'pop-eyelid' and eyelash ptosis occurred in 8% of FMF patients.
Conclusions:
- Both frontalis muscle flap and maximal anterior levator resection yield good functional and aesthetic results for congenital ptosis.
- Frontalis muscle flap surgery demonstrates a lower reoperation rate and better long-term outcomes, effectively preventing residual ptosis.
- FMF is a favorable primary surgical option for congenital ptosis with poor levator function in young children.
Purpose:
To compare 2 surgical techniques (frontalis flap versus maximal anterior levator resection) as first surgical options for the treatment of congenital ptosis with poor levator function in patients younger than 2 years of age with a follow up of 10 years.
Methods:
A retrospective study of 58 patients (71 eyelids) with severe ptosis and poor levator function who underwent frontalis muscle flap (FMF = 47) or maximal anterior levator resection (ALR = 24) for correction of their ptosis. Eyelid measurements were taken at baseline, 1, 5, and 10 years after surgery. The presence of complications, need for reoperations, and palpebral contour were evaluated.
Results:
Most patients in both groups required only one surgical procedure with a stable average margin-reflex distance 1 over the 10-year follow-up period in both groups, with no statistically significant difference between the 2 techniques in achieving an adequate palpebral height after one single procedure. Eleven eyelids treated with FMF (23%) and 12 treated with ALR (50%) needed a reoperation, with a statistically significant difference between the 2 techniques. Five ALR patients (21%) and 6 FMF patients (13%) had alterations of eyelid contour. Pop-eyelid and eyelash ptosis were observed in 8% of patients operated with FMF.
Conclusion:
Good functional and aesthetic results were obtained with both surgical techniques. FMF required fewer reoperations compared with maximal ALR, offering a better long-term result without residual ptosis.
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