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Interlocking Crawford triangles in frontalis suspension

J H Antoszyk1, N Tucker, C Ling

  • 1Department of Opthalmology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.

Archives of Ophthalmology (Chicago, Ill. : 1960)
|June 1, 1993
PubMed
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This study modified frontalis suspension surgery to prevent eyelid "cheese-wiring." Interlocking the bands centrally neutralizes opposing forces, improving aesthetic results and symmetry in patients.

Area of Science:

  • Ophthalmic plastic surgery
  • Facial reconstructive surgery

Background:

  • Crawford's frontalis suspension is a common technique for eyelid ptosis correction.
  • The standard technique can lead to "cheese-wiring" due to opposing vector forces, causing band loosening and asymmetry.

Observation:

  • Opposing forces in the eyelid center can cause the frontalis suspension bands to cut through tissue.
  • This "cheese-wiring" effect results in shortened suspensory loops and reduced efficacy of the eyelid lift.

Findings:

  • A modified frontalis suspension technique interlocks the bands centrally, neutralizing opposing forces.
  • Mathematical modeling supports this modification, demonstrating symmetrical and flexible redistribution of lifting forces.
  • Retrospective analysis of 42 cases showed good aesthetic outcomes (lid height, contour, symmetry) with no major complications.

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Implications:

  • This modified technique offers a more stable and aesthetically pleasing solution for frontalis suspension.
  • It may reduce the need for revision surgeries by preventing common complications like "cheese-wiring."
  • The findings support the use of this interlocking modification in ophthalmic plastic surgery for improved ptosis correction.