Abstract Listings 2026

Purpose

Introduction:
Management of ptosis with poor levator function remains challenging, with frontalis sling surgery commonly associated with complications like infection, extrusion, and poor lid crease formation. Frontalis flap surgery has recently gained popularity as an alternative with promising outcomes. We report outcomes of direct frontalis flap correction performed as primary or revision surgery.

Methods

A retrospective review was conducted of 6 eyes of 5 patients undergoing frontalis flap correction between February 2025 and February 2026. Preoperative and postoperative measurements at 2 weeks and 2 months included levator function (LF), MRD1, lid crease height, symmetry, lagophthalmos, and complications. Standard frontalis flap surgery with minor procedural variations was performed.

Results

Patients ranged from 8–74 years; 2 were children and 3 adults. All had congenital ptosis with poor LF. Associated conditions included Trisomy 21, mitochondrial disorders, Marcus-Gunn jaw winking, and double elevator palsy. Two eyes underwent primary surgery and four had previous failed procedures.

Mean preoperative MRD1 was 0 mm, improving to 3 mm (range 1–4 mm) at 2 months. One patient showed delayed improvement from MRD1 0 mm at 2 weeks to 3 mm at 2 months. LF remained stable except in one eye, improving from 3 mm to 6 mm postoperatively. Lid crease height was maintained or newly formed where absent. Good symmetry was achieved in all cases (mean MRD1 difference 0 mm).

One eye with preoperative lagophthalmos required temporary tarsorrhaphy for an epithelial defect but remained stable postoperatively. Another improved from 2 mm lagophthalmos preoperatively to none postoperatively. One recurrence occurred, with MRD1 decreasing from 3 mm at 2 weeks to 1 mm at 2 months, though above baseline.

Conclusion

Frontalis flap surgery shows promising functional and cosmetic outcomes in ptosis with poor LF, particularly in revision cases, and may provide a better balance between correction and lagophthalmos than frontalis sling surgery. Larger comparative studies are needed.

Additional Authors

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