Frontalis Suspension for the Correction of Blepharoptosis

Abstract

Frontalis suspension is the surgery of choice for congenital or acquired blepharoptosis with poor levator function (less than 5 mm). This procedure can be performed unilaterally or bilaterally in both children and adults. A variety of materials have been used with varying success. The ideal material is readily available, inert, adjustable, and has good, long-lasting tensile strength. Autologous materials frequently include fascia lata, temporalis fascia, and palmaris longus tendon. Allograft materials include mainly preserved fascia lata. Synthetic materials used for frontalis suspension include monofilament nylon, polypropylene, polybutylate-coated braided polyester, polyfilament cable-type suture, polyester fiber, expanded polytetrafluoroethylene (ePTFE), and silicone. Each of these materials has its own advantages and disadvantages. Adjustable sling materials may have specific advantages in patients with progressive ptosis or who are at risk for corneal decompensation. Excellent functional and aesthetic results can be obtained with frontalis slings when carefully placed with attention to surgical detail in all age groups.