Frontalis Suspension for the Correction of Blepharoptosis



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.


Fascia Lata Frontalis Muscle Frontalis Suspension Chronic Progressive External Ophthalmoplegia Palmaris Longus Tendon 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Jordan DR, Anderson RL. Obtaining fascia lata. Arch Ophthamol. 1987;105:1139–40.Google Scholar
  2. 2.
    Naugle Jr TC, Fry CL, Sabatier RE, Elliott LF. High leg incision fascia lata harvesting. Ophthalmology. 1997;104(9):1480–8.PubMedGoogle Scholar
  3. 3.
    Malhotra R, Selva D, Olver JM. Endoscopic harvesting of autogenous fascia lata. Ophthal Plast Reconstr Surg. 2007;23(5):372–75.CrossRefPubMedGoogle Scholar
  4. 4.
    Tellioglu AT, Saray A, Ergin A. Frontalis sling operation with deep temporal fascial graft in blepharoptosis repair. Plast Reconstr Surg. 2002;109(1):243–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Wong CY, Fan DSP, Ng JS, Goh TY, Lam DS. Long-term results of autogenous palmaris longus frontalis sling in children with congenital ptosis. Eye. 2005;19:546–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Lam DS, JS Ng, Cheng GP, Li RT. Autogenous palmaris longus tendon as frontalis suspension material for ptosis correction in children. Am J Ophthalmol. 1998;126:109–15.CrossRefPubMedGoogle Scholar
  7. 7.
    Medel R, Alonso T, Giralt J, Torres J, González-Candial M, García-Arumí J. Frontalis muscle flap advancement with a pulley in the levator aponeurosis in patients with complete ptosis and deep-set eyes. Ophthal Plast Reconstr Surg. 2006;22(6):441–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Broughton WL, Matthews II JG, Harris Jr DJ. Congenital ptosis. Results of treatment using lyophilized fascia lata for frontalis suspensions. Ophthalmology. 1982;89(11):1261–6.PubMedGoogle Scholar
  9. 9.
    Wilson ME, Johnson RW. Congenital ptosis; long term results of treatment using lyophilized fascia lata for frontalis suspension. Ophthalmology. 1991;98:1234–37.PubMedGoogle Scholar
  10. 10.
    Esmaeli B, Chung H, Pashby RC. Long-term results of frontalis suspension using irradiated, banked fascia lata. Ophthal Plast Reconstr Surg. 1998;14(3):159–63.CrossRefPubMedGoogle Scholar
  11. 11.
    Bodian M. Repair of ptosis using human sclera. Am J Ophthalmol. 1968;65:352–8.PubMedGoogle Scholar
  12. 12.
    Mehta P, Patel P, Olver JM. Functional results and complications of Mersilene mesh use for frontalis suspension ptosis surgery. Br J Ophthalmol. 2004;88:361–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Wasserman BN, Sprunger DT, Helveston EM. Comparison of materials used in frontalis suspension. Arch Ophthalmol. 2001;119:687–91.PubMedGoogle Scholar
  14. 14.
    Carter SR, Meecham WJ, Seiff SR. Silicone frontalis slings for the correction of blepharoptosis. Indications and efficacy. Ophthalmology. 1996;103(4):623–30.PubMedGoogle Scholar
  15. 15.
    Crawford JS. Repair of ptosis using frontalis muscle and fascia lata. Ophthalmology. 1956;60:672–8.Google Scholar
  16. 16.
    Fox SA. A new frontalis skin sling for ptosis. Am J Ophthalmol. 1968;65:359–62.PubMedGoogle Scholar
  17. 17.
    Friedenwald JS, Guyton JS. A simple ptosis operation: utilization of the frontalis by means of a single rhomboid-shaped suture. Am J Ophthalmol. 1948;31:411–4.PubMedGoogle Scholar
  18. 18.
    Tillet CW, Tillet GM. Silicone sling in the correction of ptosis. Am J Ophthalmol. 1966;62:521–3.Google Scholar
  19. 19.
    Rowan PJ, Hayes GS. Silicone sling for ptosis. South Med J. 1977;70:68–9.PubMedGoogle Scholar
  20. 20.
    Callahan MA, Beard C. Beard’s ptosis. 4th ed. Burmingham, AL: Aesculapius Publishing Company; 1990. p. 155–7, 262–5.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of OphthalmologyUniversity of California-San Francisco School of MedicineSan FranciscoUSA

Personalised recommendations