Tripartite frontalis muscle flap transposition for blepharoptosis

Area of Science:

• Ophthalmology
• Plastic Surgery
• Reconstructive Surgery

Background:

• Blepharoptosis, particularly with poor levator function, presents a surgical challenge.
• Traditional methods like maximal levator resection or frontalis suspension can lead to complications such as ptosis in superior gaze.

Purpose of the Study:

• To evaluate the efficacy and outcomes of the tripartite frontalis muscle flap technique for correcting blepharoptosis.
• To assess the incidence of complications and cosmetic defects associated with this refined surgical approach.

Main Methods:

• A tripartite frontalis muscle flap was created and sutured to the tarsus in 36 patients (54 eyelids) with blepharoptosis.
• Patients had congenital or acquired ptosis with varying degrees of levator function.
• Outcomes were assessed using Berke's criteria, forehead sensation tests, and evaluation of forehead wrinkles over an average follow-up of 32 months.

Main Results:

• The tripartite flap provided even upward pull on the tarsus without lid margin tenting.
• Ptosis in superior and primary gaze was not observed.
• Transitory lagophthalmos and mild-to-moderate lid lag were noted, resolving within 3 months.
• Forehead hypesthesia resolved completely within 24 months.
• Mild cosmetic defects (brow lowering, incomplete forehead wrinkling) occurred in 4 unilateral cases.

Conclusions:

• The tripartite frontalis muscle flap is a recommended technique for bilateral congenital ptosis with fair-to-poor levator function.
• It is also suitable for unilateral ptosis cases, especially when combined with contralateral brow lift or bilateral frontalis transposition.
• The procedure demonstrates good functional and acceptable cosmetic outcomes with minimal complications.