Frontalis Suspension through Infrabrow Skin Excision for Blepharoptosis in Asian Patients.

Abstract

Summary: Frontalis suspension is the preferred approach for blepharoptosis with compromised levator function. Various studies have explored the use of different materials or material shapes for performing this procedure; however, a limited number discuss the specifics of skin incisions. Given that blepharoplasty demands not only functional but also aesthetic results, the authors applied an infrabrow incision, a technique commonly used in cosmetic surgery. This study, the first report involving a series of blepharoptosis cases treated using this technique, explores its viability as a promising alternative to traditional frontalis suspension. This technique was used in 7 consecutive patients exhibiting poor levator function who were treated at the University of Tokyo between September of 2019 and February of 2022. A retrospective analysis was conducted on clinical photographs and charts. In 1 representative case, visual field angle and frontal muscle tone were also measured. The average duration of postoperative follow-up was 9 months. In all cases, the frontalis muscle was adequately exposed to allow suspension through the infrabrow approach. Significant improvements were observed in the marginal reflex distances without effort from -1.9 to 2.1 mm ( P = 0.0027) and marginal reflex distances with effort from 0.0 to 5.4 mm ( P < 0.0001). Complications included a hematoma ( n = 1), eyelash entropion ( n = 1), transient sensory loss of the forehead ( n = 1), and transient dry eye ( n = 3). The infrabrow incision is a good alternative for frontalis suspension owing to its capacity to offer a broad surgical field, provide effective access to the frontalis muscle, and facilitate excess skin excisions without resulting in conspicuous scarring.

Clinical question/level of evidence: Therapeutic, IV.