The septal pulley in frontalis suspension.
ABSTRACT We present a modification of the frontalis suspension for blepharoptosis, first described in 1937, that eliminates many of the drawbacks of traditional brow suspension techniques. Functional and cosmetic problems with standard suspension procedures are related to the superficial location of the sling in the eyelid, which leads to unsatisfactory geometric tenting of the pretarsal and preseptal skin, obliteration of the lid crease, and a pulling away of the upper lid from the globe with brow elevation. Eyelid height is also limited by the upper lid being pulled away from the globe. By anchoring the suspensory material behind the superior orbital septum near the arcus marginalis, more physiologic vectors of elevation are transmitted to the upper eyelid. This modification has yielded good cosmetic and functional results in 96 cases of frontalis suspension using both autogenous and allosplastic materials, and it deserves to be more widely used.
- Ophthalmic plastic and reconstructive surgery 07/2012; 28(4):239-41. · 0.69 Impact Factor
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ABSTRACT: PURPOSE: To compare nylon monofilament suture with polytetrafluoroethylene sheet for frontalis suspension surgery to treat eyes with congenital ptosis. DESIGN: Retrospective, nonrandomized, comparative, interventional case series. METHODS: We reviewed the medical records of 49 patients who had undergone 79 eyelid frontalis suspension surgeries to treat congenital ptosis. All of the patients were younger than 16 years and had congenital ptosis with poor levator muscle function. They were treated with frontalis suspension surgery with either a nylon suture or a polytetrafluoroethylene sheet and were followed up for at least 1 year. A single rhomboid loop sling was used for the nylon suture surgery. For the polytetrafluoroethylene sheet, an incision was made in the eyelid crease, and one end of the sheet was fixed to the tarsus and the other was fixed to the frontalis muscle. The main outcome measures were postoperative recurrences and complications. RESULTS: We evaluated 37 eyelids of 25 patients after nylon suture surgery and 42 eyelids of 31 patients after polytetrafluoroethylene sheet surgery. Among these, 9 eyelids of 7 patients were included in both groups. The median postoperative follow-up period was 32 months in both groups. The recurrence rates were 62.2% for the nylon suture group and 0% for the polytetrafluoroethylene sheet group (P < .001). The postoperative complication rates were 0% for the nylon suture group and 7.1% for the polytetrafluoroethylene sheet group (P > .05). CONCLUSIONS: Frontalis suspension using a polytetrafluoroethylene sheet with direct tarsus and frontalis muscle fixation is a reasonable technique with low rates of recurrences and complications.American journal of ophthalmology 01/2013; · 3.83 Impact Factor
Chapter: The History of Ptosis Surgery[show abstract] [hide abstract]
ABSTRACT: From an inexact origin of trial and error, blepharoptosis surgery has become a scientific art. The arc of its technical development parallels that of anatomical discoveries and surgical materials. Approaches have varied, as have the tissues of interest, and with increasingly reliable results in the reconstructive domain came greater expectations and the development of its cosmetic counterpart. That said, for some diseases associated with blepharoptosis, an ideal surgery remains elusive. This chapter provides a chronological account of the treatment of blepharoptosis with attention paid to the tissues involved. The rich history of blepharoptosis surgery provides a fertile matrix for the field of oculofacial plastic surgery, and in return, the field continues to evolve blepharoptosis’ surgical treatment.12/2010: pages 5-11;