C-Shaped Frontalis Muscle Flap Suspension for Congenital Blepharoptosis: A Retrospective Analysis of Outcomes in Moderate to Severe Cases.

Background: While various surgical techniques have been developed for blepharoptosis correction, the frontalis suspension technique is commonly applied in cases of poor levator function or prior surgical history. This study evaluates the efficacy of a modified frontalis muscle flap suspension technique in achieving satisfactory outcomes for severe or recurrent blepharoptosis with poor levator function. Methods: A retrospective study conducted from January 2014 to January 2017 reviewed the medical records of 47 patients with a mean age of 17.3 ± 9.17 years at 108 Military Central Hospital, Ha Noi, Vietnam. These patients were diagnosed with moderate to severe blepharoptosis (marginal reflex distance 1, MRD1 0-2 mm) with poor levator function (<4 mm) and underwent modified C-shaped frontalis muscle flap suspension. The outcomes were measured by the sum of functional and cosmetic grading scales at 6- and 12-month follow-ups. Postoperative complications were also noted. Results: There are 40 patients (85.1%) who have unilateral ptosis and 7 (14.9%) who have bilateral ptosis. Forty-seven patients (87%) had severe ptosis, while seven (13%) had moderate ptosis. A history of frontalis sling surgery was present in 38.9% of patients. At the 12-month follow-up, 37 patients (78.7%) had good outcomes, 9 patients (19.1%) had fair outcomes, and 1 patient (2.1%) had poor outcomes that underwent surgical revision. Conclusion: Our analysis of the modified C-shaped frontalis muscle flap suspension technique demonstrates its efficacy in treating moderate and severe blepharoptosis, particularly in cases with poor levator function and prior surgical history.