The Septal Pulley in Frontalis Suspension
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.
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