Combined levator and frontalis muscle advancement flaps for recurrent severe congenital ptosis

Background To evaluate the outcomes of combined levator resection and frontalis muscle advancement for surgical management of recurrent severe congenital ptosis. Design Retrospective, nonrandomized interventional case series. Methods A retrospective review was performed of patients who underwent combined levator resection and frontalis muscle advancement for recurrent congenital ptosis between 2017 and 2020. Inclusion criteria were levator function of 4 mm or less and margin reflex distance 1 (MRD1) of 0 mm or less. Main outcome measures were postoperative MRD 1, lagophthalmos, lash angle, and grades of eyelid contour and crease. The outcomes were assessed by reviewing medical charts and photographs. Results Thirty-one patients (35 eyelids) met the inclusion criteria. The mean preoperative MRD1 was -1.14 +/- 1.56 mm, which improved to 3.93 +/- 0.52 mm with an average lagophthalmos of 0.91 +/- 0.74 mm at the last follow-up. A total of 91.4% of eyelids had excellent eyelid contour, crease, and eyelash angle at the final follow-up. One eyelid required revision surgery. There were no other significant complications. Conclusions For poor function recurrent congenital ptosis, combining levator resection and frontalis muscle advancement is an effective method that results in long-term correction with cosmetically pleasing outcomes and minimal complications.