title: Frontalis suspension for upper eyelid ptosis: evaluation of different surgical designs and suture material.
abstract: OBJECTIVE
  To compare two sling designs (single loop or double pentagon) and a variety of suture material that was used in frontalis suspension surgery for correction of upper eyelid ptosis.
  
  
  METHODS
  Retrospective, nonrandomized, comparative interventional case series.
  
  
  METHODS
  Medical record review of 99 patients (164 surgeries) who underwent frontalis suspension surgery for upper eyelid ptosis was conducted at the Jules Stein Eye Institute in 1996 to 2002. Functional and cosmetic success, margin reflex distance (MRD) and lagophthalmos were evaluated.
  
  
  RESULTS
  MRD increased an average of 1.1 mm after the operation (P < .001). Ptosis recurrence was noticed in 42 cases (26%); polytetrafluoroethylene achieved the lowest recurrence rate (15%), although not statistically significant. No difference in functional success, ptosis recurrence, or change in MRD was noticed between single loop and double pentagon design. A better cosmetic outcome was noted in cases in which nylon suture was used. Complications included four cases (2.4%) of over-correction, three cases (1.8%) of suture infection (all in polytetrafluoroethylene), two cases of pyogenic granuloma (1.2%), and two cases (1.2%) of suture exposure.
  
  
  CONCLUSIONS
  Frontalis suspension for upper eyelid ptosis resulted in 26% ptosis recurrence after a mean of 12 months from first surgery. Polytetrafluoroethylene showed the lowest incidence of ptosis recurrence. No statistically significant difference was found between different suture materials or loop shape that was used in the surgical technique. A better cosmetic outcome, as graded by different observers, was noted in cases in which a nylon sling was used.
authors.affiliation: Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, CA 90095-7006, USA. guybensimon@gmail.com
authors.forename: Guy J
authors.initials: GJ
authors.lastname: Ben Simon
authors.forename: Aisha A
authors.initials: AA
authors.lastname: Macedo
authors.forename: Robert M
authors.initials: RM
authors.lastname: Schwarcz
authors.forename: Debbie Y
authors.initials: DY
authors.lastname: Wang
authors.forename: John D
authors.initials: JD
authors.lastname: McCann
authors.forename: Robert A
authors.initials: RA
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D019882:Blepharoplasty / Q000379:methods*; D001763:Blepharoptosis / Q000503:physiopathology / Q000601:surgery*; D005143:Eyelids / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D009757:Nylons; D009801:Oculomotor Muscles / Q000601:surgery*; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D012826:Silicone Elastomers; D013536:Suture Techniques; D013537:Sutures
chemical_list: D009757:Nylons; D012826:Silicone Elastomers; D011138:Polytetrafluoroethylene