Frontalis Sling

  • Ying Chen
  • Adam C. Weber
  • Douglas P. Marx
  • Richard C. Allen
  • Mark R. LevineEmail author


Frontalis suspension is often reserved for cases of congenital ptosis with poor levator function and progressive myogenic ptosis in the adult. Various procedures have been proposed throughout the years to attain optimal function and cosmesis. In addition, various materials for the suspension material have been promulgated. The purpose of this chapter is to describe the preferred procedures and materials of the authors for poor levator function congenital ptosis and progressive myogenic ptosis in the adult.


Congenital ptosis Frontalis sling Frontalis suspension Progressive myogenic ptosis Chronic progressive external ophthalmoplegia (CPEO) Oculopharyngeal muscular dystrophy (OPMD) Myotonic dystrophy Autogenous fascia lata Autogenous fascia lata graft 



The authors have no funding, financial relationships, or conflicts of interest to disclose. All subjects involved in the study cited in Part I gave informed consent for the treatment described.

Supplementary material

419986_5_En_18_MOESM1_ESM.mp4 (242.8 mb)
Video 18.1 Fascia frontalis sling (Courtesy of Richard C. Allen, MD, PhD, FACS. (MP4 248608 kb))
419986_5_En_18_MOESM2_ESM.mp4 (108 mb)
Video 18.2 Pediatric bilateral frontalis sling (Courtesy of Richard C. Allen, MD, PhD, FACS. (MP4 110593 kb))
419986_5_En_18_MOESM3_ESM.mp4 (145.9 mb)
Video 18.3 Silicone frontalis sling for congenital ptosis (Courtesy of Richard C. Allen, MD, PhD, FACS. (MP4 149411 kb))
419986_5_En_18_MOESM4_ESM.mp4 (135.3 mb)
Video 18.4 Bilateral silicone frontalis suspension (Courtesy of Richard C. Allen, MD, PhD, FACS. (MP4 138556 kb))
419986_5_En_18_MOESM5_ESM.mp4 (175 mb)
Video 18.5 Revision of silicone frontalis sling (Courtesy of Richard C. Allen, MD, PhD, FACS. (MP4 179241 kb))
419986_5_En_18_MOESM6_ESM.mp4 (113.7 mb)
Video 18.6 Autogenous fascia harvest (Courtesy of Richard C. Allen, MD, PhD, FACS. (MP4 116406 kb))
419986_5_En_18_MOESM7_ESM.mp4 (100.1 mb)
Video 18.7 Close-up of autogenous fascia harvest (Courtesy of Richard C. Allen, MD, PhD, FACS. (MP4 102511 kb))

Suggested Readings

  1. 1.
    Hayashi K, Katori N, Kasai K, Kamisasanuki T, Kokubo K, Ohno-Matsui K. Comparison of nylon monofilament suture and polytetrafluoroethylene sheet for frontalis suspension surgery in eyes with congenital ptosis. Am J Ophthalmol. 2013;155(4):654–63 e1.CrossRefPubMedGoogle Scholar
  2. 2.
    Lee J, Lee H, Chang M, Park M, Baek S. Clinical results of modified frontalis suspension technique using preserved fascia lata for congenital ptosis. J Craniofac Surg. 2016;27(5):e477–81.CrossRefPubMedGoogle Scholar
  3. 3.
    Levine M. Manual of oculoplastic surgery. 4th ed. Thorofare: SLACK Incorporated; 2010.Google Scholar
  4. 4.
    Qiu SS, Hontanilla B. Congenital ptosis of the upper eyelid corrected by a modified frontalis suspension technique using autogenous tendons. Ann Plast Surg. 2011;67(2):129–33.CrossRefPubMedGoogle Scholar
  5. 5.
    Tanenbaum RE, Shi W, Johnson TE, Wester ST. Frontalis suspension with supramid suture: longevity results in very young patients with congenital ptosis. Ophthal Plast Reconstr Surg. 2014;30(2):110–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Woo KI, Kim YD, Kim YH. Surgical treatment of severe congenital ptosis in patients younger than two years of age using preserved fascia lata. Am J Ophthalmol. 2014;157(6):1221–6 e1.CrossRefPubMedGoogle Scholar
  7. 7.
    Preferred methods for ptosis repair in the pediatric population: a survey of ASOPRS members. In: Murdock J, Law N, Thyparampil P, Yen MT, Marx DP. American society of ophthalmic plastic and reconstructive surgery fall symposium, November 12, 2015, Las Vegas NV.Google Scholar
  8. 8.
    Allen RC, Zimmerman MB, Watterberg EA, Morrison LA, Carter KD. Primary bilateral silicone frontalis suspension for good levator function ptosis in oculopharyngeal muscular dystrophy. Br J Ophthalmol. 2012;96:841–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Allen RC, Hong ES, Zimmerman MB, Morrison LA, Nerad JA, Carter KD. Factors affecting eyelid crease formation before and after silicone frontalis suspension for adult-onset myogenic ptosis. Ophthal Plast Reconstr Surg. 2015;31:227–32.CrossRefPubMedGoogle Scholar
  10. 10.
    Patrinely JR, Anderson RL. The septal pulley in frontalis suspension. Arch Ophthalmol. 1986;104:1707–10.CrossRefPubMedGoogle Scholar
  11. 11.
    Buttanri IB, Serin D, Karslioglu S, Akbaba M, Ari S, Fazil K. Effect of suturing the silicone rod to the tarsal plate and the suture material used on success of frontalis suspension surgery. Ophtal Plast Reconstr Surg. 2013;29:98–100.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Ying Chen
    • 1
  • Adam C. Weber
    • 2
  • Douglas P. Marx
    • 3
  • Richard C. Allen
    • 4
  • Mark R. Levine
    • 5
    • 6
    • 7
    Email author
  1. 1.Department of OphthalmologyBascom Palmer Eye Institute, University of Miami Health SystemsMiamiUSA
  2. 2.Department of OphthalmologyCullen Eye Institute, Baylor College of MedicineHoustonUSA
  3. 3.Department of OphthalmologyUniversity of UtahSalt Lake CityUSA
  4. 4.Department of OphthalmologyCullen Eye Institute, Baylor College of MedicineHoustonUSA
  5. 5.Case Western Reserve University School of MedicineClevelandUSA
  6. 6.Department of OphthalmologyUniversity Hospitals of ClevelandClevelandUSA
  7. 7.Cleveland Clinic FoundationClevelandUSA

Personalised recommendations