Three-Row Fixation of Fascia Lata in Frontalis Sling Procedure for Severe Congenital Blepharoptosis

Background and objective: Multiple surgical procedures and materials are available for correcting congenital blepharoptosis. Thus, we aimed to evaluate the efficacy of the fascia Lata fixation to the tarsal plate for achieving a more natural appearance of the upper eyelid and reducing the likelihood of ptosis recurrence in patients with congenital blepharoptosis. Patients and methods: This single-arm prospective study was done from September 2021 to January 2023 in Sulaimani Burn and Plastic Surgery Hospital, Sulaimaniyah City, Iraq on12 patients (14 eyes) with severe congenital blepharoptosis that underwent frontalis sling surgery using autologous fascia Lata. The central fascia lata was stitched to the tarsal plate by suturing in three horizontal rows to give more natural upper eyelids. Then, the two trimmings of fascia Lata were dragged by small incisions in the suprabrow region to adjust the upper eyelid position to correct the ptosis. Results: Using frontalis sling operation, the outcomes were good in most patients (11 eyes, 78.57%) and moderate in 3 eyes (21.42%), while no patients reported poor outcome. Frontalis sling operation also enhanced the secure connection of the fascia lata to the tarsal plate and provided a more natural appearance of the upper eyelid and eyelid crease. Conclusion: Three-row fixation of fascia Lata using the frontalis sling procedure is an effective technique for correcting severe ptosis. It results in more natural-looking upper eyelids and potentially reduces the risk of ptosis recurrence.