Refined frontalis fascial sling with proper lid crease formation for blepharoptosis.

Ptosis of the upper eyelid is a complicated problem, and many surgical techniques have been developed for the treatment of ptosis. Frontalis sling with autogenous fascial strip for the correction of severe ptosis with poor levator function is still well accepted. The treatment necessitates an understanding of the etiology of ptosis, detailed history taking, degree of ptosis, the levator function, the anatomic basis of the ptosis and lid crease, and a historic review of surgical procedures. The refinement of our procedure consists of a circular type of frontalis sling with an autogenous fascial strip, harvested from fasciae latae or temporalis fascia, with evenly balanced strength and partial lid resection, including a semilunar segment of skin flap and orbicularis muscle and moderate amount of protruded orbital fat from the orbital septum. The fascial strip is anchored simultaneously to the upper margin of the tarsal plate and incision margin of the pretarsal lid to produce a proper lid crease. This procedure has been successful in the management of 64 lids (46 patients) with a severe degree of ptosis and poor levator function. Satisfactory results have been achieved in 57 lids (89 percent) according to the modified criteria of Berke after an average follow-up period of 18.5 months. Most patients (87.5 percent) have mild lid lag (1 to 3 mm) after the operation, but 58 lids (90.6 percent) achieved a proper lid crease height of 3 to 6 mm.