The Effect of Two Different Frontalis Sling Approaches on Postoperative Eyelid Contour: A Comparative Study

Abstract

Purpose To compare two different frontalis sling approaches, tarsal fixation and orbicular muscle fixation, using silicone rod (FCI Ophthalmics, Marshfield Hills, MA, USA) in terms of postoperative upper eyelid contour in patients with poor levator muscle function. Design Retrospective, comparative, case series. Methods Ten eyes of seven patients who received frontalis sling surgery with orbicularis muscle fixation (group 1), eight eyes of seven patients who received frontalis sling surgery with tarsal fixation (group 2) and 30 eyes of 15 age and sex-matched healthy controls (control group) were included. Postoperative photographs of all the participants were taken in the primary gaze, and each photograph was viewed on a computer. The distance between the upper lid margin and pupillary center (MCD), nasal limbus (MND), and temporal limbus (MTD) was measured, respectively, using the ruler in Microsoft Paint Software and compared with each other for each participant. Results Both nasal, central and temporal margin distance values in group 1 and group 2 were significantly lower than those of the control group ( p \xa0<\xa00.05 for all values). The ratio of MTD/MCD in the control group was significantly higher than group 1 ( p \u2009=\u20090.04) besides the ratio of MND/MTD in the control group was significantly lower than group 1 ( p \u2009=\u20090.01). Discussion Frontalis sling approach with tarsal fixation using silicone rod might provide improved cosmetic results including more symmetrical upper eyelid contour compared with orbicularis muscle fixation approach. Moreover, the novel measuring technique presented in the current study provides a simple and effective assessment of the upper lid contour in daily practice setting. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .