Related Experiment Video
Updated: Mar 29, 2026
Surgical Correction for Pediatric Epiblepharon and Trichiasis
Published on: July 8, 2025
Modified Conjoint Fascial Sheath Suspension Technique with Tri-Plane Dissection and Dual-Ligament Fixation for Severe
Wenwen Xi1, ZiQing He1, Jianfei Zhang1
1Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, 35 Jiefang Avenue, Zhengxiang District, Hengyang, Hunan 421000, China.
Background:
Severe blepharoptosis (MRD1 ≤0 mm with levator function ≤3 mm) poses significant surgical challenges. This study evaluates the efficacy and safety of a modified conjoint fascial sheath (CFS) suspension technique incorporating tri-plane dissection and dual-ligament suspension.
Methods:
A retrospective cohort of 105 patients (123 eyelids) with severe blepharoptosis treated between January 2023 and February 2024 was divided into conventional CFS (n=59 eyelids) and modified CFS groups (n=64 eyelids). The novel technique featured: (1) Tri-plane anatomical dissection (levator aponeurosis plane, Müller's muscle-conjunctival plane, CFS-scleral plane); (2) Dual-ligament suspension (CFS and the check ligament of the superion fornix ); (3) Dual-Ω suture technique for four-layer conjunctival plication. Outcomes included correction efficacy, eyelid retraction, lagophthalmos, complications, and patient satisfaction.
Results:
The modified group demonstrated superior outcomes: higher correction rate (93.75% vs 77.97%, p=0.011), reduced complications (6.25% vs 20.34%, p=0.021), and greater patient satisfaction (89.09% vs 74.00%, p=0.045). No conjunctival prolapse occurred in the modified group versus 13.56% in controls.
Conclusion:
This tri-plane dissection with dual-ligament suspension system achieves precise anatomical reconstruction while minimizing conjunctival complications. The technical refinements address the critical limitation of insufficient height after conventional CFS suspension, offering a reproducible solution for severe ptosis correction.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
