Purpose

Describe a technical variant of frontal suspension using a rectangular design and evaluate its advantages in terms of simplicity, intraoperative control and aesthetic result.

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Methods

A 60-year-old patient with Steinert’s myotonic dystrophy and advanced ptosis with pupillary axis occlusion.
A variant of the frontalis suspension technique is proposed, in contrast to classic designs (Fox or Crawford), consisting of a rectangular incision. 3-0 prolene sutures are used, with two suprciliar incisions (at the head and tail of the eyebrow) and one incision in the palpebral crease.
The lower segment of the rectangle is fixed to the upper third of the tarsal plate using several non-absorbable sutures, adjusted intraoperatively to optimize eyelid height and contour. The ends are anchored in the upper incision at the level of the head of the eyebrow.

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Results

Traditional forehead suspension techniques employ more complex geometric configurations that may require multiple incisions and limit intraoperative fine-tuning.
The rectangular configuration simplifies the procedure, reduces the number of incisions, and allows for more precise control of tension and eyelid contour. The use of non-absorbable material provides long-term stability and reversibility a relevant factor in patients with myopathies.
Furthermore, locating the incisions right above the eyebrow hairs improves the aesthetic outcome by avoiding visible forehead scars.

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Conclusion

The rectangular frontalis suspension technique is a simple and reproducible method that allows for adequate intraoperative control of eyelid height and contour, with fewer incisions and a good aesthetic result. It represents a useful alternative to traditional techniques.

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Additional Authors

First name	Last name	Base Hospital / Institution
Alejandra	Alvarez Brandt	Hospital Universitario de Fuenlabrada
Raquel	Lapuente Monjas	Hospital Universitario de Fuenlabrada

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