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Conjoint Fascial Sheath Suspension for Severe Blepharoptosis through Palpebral Margin Incision

  • Original Article
  • Oculoplastic
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Conjoint fascial sheath suspension can achieve pleasing surgical efficacy and dynamic eyelid movement in the treatment of severe ptosis. In recent years, the palpebral margin incision technique has been applied for double-eyelid blepharoplasty, which is characterized by inconspicuous scarring, short convalescence, and natural-looking outcome. However, studies of the application of this technique in the treatment of ptosis are scarce. This article aims to evaluate the efficacy and safety of conjoint fascial sheath suspension for treating severe blepharoptosis through palpebral margin incision.

Methods

From March 2019 to January 2021, 32 patients (37 eyelids) underwent treatment with the modified technique. Preoperatively, levator muscle function and margin reflex distance 1 were documented. Correction effects, symmetry results, and complications were also evaluated postoperatively.

Results

Adequate or normal correction was achieved in 33 eyelids (89.2%), and 31 patients (96.9%) obtained good or fair symmetry results. Common complications were undercorrection and conjunctival prolapse, which were both observed in four eyelids (10.8%), followed by overcorrection and hematoma.

Conclusions

The modified technique provides physical eyelid elevation and inconspicuous scarring and is effective for treating severe ptosis. Satisfactory functional and esthetic results could be obtained simultaneously without severe complications.

Level of Evidence IV

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References

  1. Fea A, Damato D, Actis AG, De Sanctis U, Actis G, Grignolo FM (2013) Blepharoplastic: essential review. Minerva Chir 68:49–56

    CAS  PubMed  Google Scholar 

  2. Sokol JA, Thornton IL, Lee HB et al (2011) Modified frontalis suspension technique with review of large series. Ophthalmic Plast Reconstr Surg 27:211–215

    Article  Google Scholar 

  3. Isaksson I (1962) Studies on congenital genuine blepharoptosis: morphological and functional investigations of the upper eyelid. Acta Ophthalmol Suppl 72:1–121

    CAS  PubMed  Google Scholar 

  4. Mokhtarzadeh A, Harrison AR (2015) Controversies and advances in the management of congenital ptosis. Expert Rev Ophthalmol. 10(1):59–63

    Article  CAS  Google Scholar 

  5. Tianyi L, Haiyan S, Fei L et al (2010) Blepharoptosis correction by excision of levator muscle and tarsus in Asians. J Craniofac Surg 21(3):652–625

    Article  Google Scholar 

  6. Crawford JS (1997) Repair of ptosis using frontalis muscle and fascia lata: a 20-year review. Ophthalmic Surg 8:31–40

    Google Scholar 

  7. Goldey SH, Baylis HI, Goldberg RA, Shorr N (2000) Frontalis muscle flap advancement for correction of blepharoptosis. Ophthalmic Plast Reconstr Surg 16(2):83–93

    Article  CAS  Google Scholar 

  8. Krohn-Hansen D, Haaskjold E, Nicolaissen B (2015) Suspension surgery with autogenous fascia lata via a less invasive modification of the Crawford method on 85 patients with congenital severe eyelid ptosis. J Plast Surg Hand Surg 49(4):214–219

    Article  Google Scholar 

  9. Liu F, Yang F, Luo XS, Dong JS, Chin B, Yang J (2012) A modified technique combining excision of the levator muscle and tarsus for blepharoptosis in Asians: a 6-year experience with 116 cases. Aesthetic Plast Surg 36(1):41–48

    Article  Google Scholar 

  10. Baik BS, Ha W, Lee JW et al (2014) Adjunctive techniques to traditional advancement procedures for treating severe blepharoptosis. Plast Reconstr Surg 133(4):887–896

    Article  CAS  Google Scholar 

  11. Murakami CS, Plant RL (1994) Complications of blepharoplasty surgery. Facial Plast Surg 10(2):214–224

    Article  CAS  Google Scholar 

  12. Mustardé JC (1975) Problems and possibilities in ptosis surgery. Plast Reconstr Surg 56(4):381–388

    Article  Google Scholar 

  13. Hwang K (2013) Surgical anatomy of the upper eyelid relating to upper blepharoplasty or blepharoptosis surgery. Anat Cell Biol. 46:93–100

    Article  Google Scholar 

  14. Holmström H, Santanelli F (2002) Suspension of the eyelid to the check ligament of the superior fornix for congenital blepharoptosis. Scand J Plast Reconstr Surg Hand Surg 36(3):149–156

    Article  Google Scholar 

  15. Zhou J, Chen W, Qi Z, ** X (2019) Minimally invasive conjoint fascial sheath suspension for blepharoptosis correction. Aesthetic Plast Surg 43(4):956–963

    Article  Google Scholar 

  16. **ng Y, Wang X, Cao Y et al (2019) Modified combined fascia sheath and levator muscle complex suspension with Müller muscle preservation on treating severe congenital ptosis. Ann Plast Surg 82(1):39–45

    Article  CAS  Google Scholar 

  17. Fang S, Zhu W, **ng X, Zhu L, Yang C (2018) Double eyelid surgery by using palpebral marginal incision technique in Asians. J Plast Reconstr Aesthet Surg 71(10):1481–1486

    Article  Google Scholar 

  18. Gu T, Wang Y, Chen W (2020) Comparison of palpebral marginal and traditional incision techniques for double-eyelid surgery. Aesthetic Plast Surg 44(3):799–807

    Article  Google Scholar 

  19. Berke RN (1952) A simplified Blaskovics operation for blepharoptosis; results in ninety-one operations. AMA Arch Ophthalmol 48(4):460–495.

  20. Park DH, Jung JM, Song CH (2008) Anthropometric analysis of levator muscle function. Plast Reconstr Surg 121(4):1181–1187

    Article  CAS  Google Scholar 

  21. Putterman AM (2012) Margin reflex distance (MRD) 1, 2, and 3. Ophthalmic Plast Reconstr Surg 28:308–311

    Article  Google Scholar 

  22. Collin JR (1979) Complications of ptosis surgery and their management: a review. J R Soc Med 72:25–26

    Article  CAS  Google Scholar 

  23. Ahmad SM, Della Rocca RC (2007) Blepharoptosis: evaluation, techniques, and complications. Facial Plast Surg 23:203–215

    Article  CAS  Google Scholar 

  24. Holmström H, Bernström-Lundberg C, Oldfors A (2002) Anatomical study of the structures at the roof of the orbit with special reference to the check ligament of the superior fornix. Scand J Plast Reconstr Surg Hand Surg 36(3):157–159

    Article  Google Scholar 

  25. Hwang K, Shin YH, Kim DJ (2008) Conjoint fascial sheath of the levator and superior rectus attached to the conjunctival fornix. J Craniofac Surg 19:241–245

    Article  Google Scholar 

  26. Ahn TJ, Kim JH, Lee EI et al (2017) Nonincisional conjoint fascial sheath suspension: a novel technique for minimally invasive blepharoptosis correction. Ann Plast Surg 79(4):334–340

    Article  CAS  Google Scholar 

  27. Gutman J, Pointdujour R, Shinder R (2012) Complications of blepharoptosis surgery. Arch Ophthalmol 130:666

    Article  Google Scholar 

  28. Lee J, Lee H, Chang M, Park M, Baek S (2016) Clinical results of modified frontalis suspension technique using preserved fascia lata for congenital ptosis. J Craniofac Surg 27(5):e477-481

    Article  Google Scholar 

  29. Santanelli F, Paolini G, Renzi LF, Longo B, Pagnoni M, Holmström H (2011) Correction of myopathic blepharoptosis by check ligament suspension: clinical evaluation of 89 eyelids. J Plast Surg Hand Surg 45(4–5):194–199

    Article  Google Scholar 

  30. Chen AD, Lai YW, Lai HT et al (2016) The impact of Hering’s law in blepharoptosis: literature review. Ann Plast Surg 76(Suppl 1):S96–S100

    Article  CAS  Google Scholar 

Download references

Acknowledgement

The authors declare that they have no conflict of interest.

Funding

This study was financially supported by the National Natural Science Foundation for Youth Scholars (grant no. 81401613), the Shanghai Municipal Key Clinical Specialty (grant no. shslczdzk00901) and the Clinical Research Program of 9th People's Hospital, Shanghai Jiao Tong University School of Medicine (grant no. JYLJ202104).

Author information

Author notes

  1. Yucheng Qiu and Di Sun are contributed equally to the acquisition, analysis, and treatment of data and should be viewed as co-first authors.

Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, China

    Yucheng Qiu, Di Sun, Jun Yang & Fei Liu

  2. Department of Plastic and Reconstructive Surgery, Nanchang Fanbo Medical Beauty Hospital, 129 Luyin Road, Nanchang, 330000, Jiangxi, China

    **bin Pan

  3. Department of Plastic and Reconstructive Surgery, Shenzhen Meilai Medical Beauty Hospital, 2044 Shennan Middle Road, Shenzhen, Guangdong, 518000, China

    Yan ** & Lisha Cai

  4. Department of Plastic and Reconstructive Surgery, Shenzhen Nanxizi Medical Beauty Hospital, 201 Runpeng garden, 1072 Lianhua Road, Shenzhen, Guangdong, 518034, China

    Dengwen Lin

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  1. Yucheng Qiu
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  2. Di Sun
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  3. **bin Pan
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  6. Jun Yang
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Correspondence to Dengwen Lin or Fei Liu.

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Qiu, Y., Sun, D., Pan, P. et al. Conjoint Fascial Sheath Suspension for Severe Blepharoptosis through Palpebral Margin Incision. Aesth Plast Surg 46, 2301–2309 (2022). https://doi.org/10.1007/s00266-022-02771-4

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  • DOI: https://doi.org/10.1007/s00266-022-02771-4

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