The Use of Whitnall’s Ligament for Sling Redirection in Frontalis Suspension Ptosis Surgery

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Abstract

Purpose:

To evaluate the cosmetic and functional outcome of a modified frontalis suspension technique when the sling force vector is redirected through Whitnall’s ligament.

Methods:

Non-comparative retrospective study. Twenty-nine eyes of 23 patients with poor levator function of 4 mm or less. Patients underwent frontalis suspension with polytetrafluoroethylene (Gore-Tex) (PTFE). The sling was inserted in a single circular fashion through 3 brow incisions. An additional eyelid crease incision was created to allow the passage of the sling beneath Whitnalls’ ligament, to permit securing the sling to the tarsus, to perform a limited blepharoplasty, and to reform the eyelid crease. Postoperatively, patients were followed up for at least 24 months.

Results:

All cases achieved elevation of the ptotic eyelid in the primary position. Three eyes of 2 patients had under correction in the primary gaze. Twenty-eight of 29 eyes retained the same level of eyelid elevation after 2 years of follow up. Symmetry in the primary gaze was achieved in 4 of 6 (67%) patients with bilateral ptosis and in 12 of 17 (71%) patients with unilateral ptosis. One patient had sling infection with granuloma formation. Lagophthalmos was common, but none developed exposure keratitis.

Conclusions:

Frontalis suspention technique modified with redirecting the sling pulling force vector by passing beneath Whitnall’s ligament can achieve a natural-looking eyelid in primary gaze and does not interfere with functional outcome.

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