A Dynamic Technique for the Treatment of Severe or Recurrent Blepharoptosis: Frontalis-Orbicularis Oculi Muscle Flap Shortening

Abstract

Background: Severe or recurrent blepharoptosis remains a great challenge to most plastic surgeons. A variety of techniques have been developed according to the function of the levator palpebrae superioris and frontalis muscles. In this study, the frontalis-orbicularis oculi (FOO) muscle flap is designed as an entity to treat severe or recurrent blepharoptosis with satisfactory results. Methods: Between January 1997 and July 2007, FOO muscle flap shortening was applied to correct severe or recurrent blepharoptosis in 29 patients (38 eyelids), aged from 3 to 77 years. There were 11 males and 18 females, with bilateral ptosis in 9 patients. The follow-up period ranged from 10 to 52 months. Results: Twenty-four patients (82%) had good results, with the degree of ptosis less than 2 mm. The remaining 5 patients had fair results, and received readjustment in 2 cases. Conclusion: In our study, fresh cadaver dissection revealed that the frontalis muscle is connected and interdigitated very closely with the orbicularis oculi muscle. Based on the anatomic study and literature review, we suggest that the FOO muscle flap shortening is a good alternative to treat severe or recurrent blepharoptosis.

Direct Tarsus to Frontalis Muscle Sling without Flap Creation for Correction of Blepharoptosis with Poor Levator Function

“…According to previous reports, frontalis sling can be used for recurrent ptosis following sling procedures or levator resection (Tsai et al, 2003;Park and Choi, 2002;Lai et al, 2009;Tong et al, 2000;Zhou and Chang, 1988;Leibsohn, 1995;Han and Kang, 1993;Park et al, 2007). We also observed no correlation between prior ptosis surgery and surgical success.…”

The Function-Preserving Frontalis Orbicularis Oculi Muscle Flap for the Correction of Severe Blepharoptosis With Poor Levator Function

“…The frontalis muscle flap has demonstrated long-term elasticity and contractility, which is consistent with the histologic findings in our previous reports. 16 , 17 , 32 Unlike the interdigital OOM flap suspension described by Wang et al, 32 who successfully treated moderate to severe blepharoptosis, the rectangular function-preserving FOOM flap with minimal involvement of the lower part of the orbital OOM creates an evenly distributed force in the frontalis movement. Additionally, in order to keep the orbital septum intact, submuscular dissection was performed at the upper margin of the eyebrow, thereby minimizing surgical interruption of the anatomic integrity of the upper eyelid.…”

“…The distinct anatomic continuation of the frontalis muscle and orbital OOM exerts a dynamic action on the muscles involved, which is the concept that was applied to the inception of the FOOM flap-shortening technique to address upper lid blepharoptosis. 16 , 17 The frontalis muscle transfer technique, on the other hand, involves advancement of the muscular flap that connects directly to the tarsus without disturbing the OOM. 18-20 However, the direct transfer of pure frontalis muscle may cause overcorrection of ptosis.…”

“… 21-25 Previous FOOM flap-shortening procedures inevitably required sacrifice of a variable portion of the OOM during upper eyelid adjustment, which potentially affected its function. 16 , 17 , 23-25 As a result, the function-preserving FOOM flap was developed by the senior author to correct severe blepharoptosis with poor LF while preserving the anatomic and functional integrity of the OOM. This study aimed to assess the surgical outcomes of this innovative technique, particularly with respect to postoperative lagophthalmos.…”

Surgical Treatment of the Synkinetic Eyelid Closure in Marin-Amat Syndrome

“…Furthermore, according to our previous experience concerning surgical treatment of the upper blepharoptosis by shortening of the frontalis-OOM flap, resection of the preseptal OOM did not interfere with eyelid closure. [13][14][15] Since the pretarsal and orbital OOMs are preserved, the patient can still close the eyes smoothly.…”