An frontalis sling operation using an autogenous en-bloc, fan-shaped tensor fascia lata graft for blepharoptosis.

This article presents a modification of the frontalis sling operation for severe blepharoptosis with poor levator function. The fascia or other suspension materials are usually used in strip form to avoid a mass under the skin and lid-crease obliteration in the frontal sling operations. However, the 'strip-sling technique' carries the risk of some complications including irregular eyelid contour, unstable fixation and loss of elevating power in the follow-up period. To overcome these complications and to enhance elevating power transmission between the tars and the frontal muscle, the autogenous tensor fascia lata graft was designed to be en bloc and fan-shaped. This technique was used in nine patients (12 eyelids) who presented with different aetiologies. They had an average follow-up of 13.5 months. Although all the patients achieved favourable results with good eyelid opening, the patients who had traumatic ptosis were more prone to complications including lagophtalmos and pulling away problem. This modification appears to increase the surface contact area between the frontalis muscle, the fascia lata graft and the tarsus. This increased contact enhances tarsus elevation in ptotic eyelids and is associated with satisfactory results.