The Role of Frontalis Orbicularis Oculi Muscle Flap for Correction of Blepharoptosis With Poor Levator Function

Lai, Chung-Sheng; Chang, Kao-Ping; Lee, Su-Shin; Hsieh, Tung-Ying; Lai, Hsin-Ti; Huang, Yuhao; Lai, Ya-Wei

doi:10.1097/sap.0000000000000043

Cited by 22 publications

(15 citation statements)

References 26 publications

(16 reference statements)

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“…Nemet 15 did not find any association between Hering's phenomenon and palpebralis function in a study of 35 patients with congenital ptosis. In a study by Lai et al, 16 only 17.6% of patients with unilateral ptosis who had poor palpebralis function exhibited a positive Hering's phenomenon. Up to now, the relationship between palpebralis function and the Hering's phenomenon is not clear.…”

Section: Discussionmentioning

confidence: 91%

Retrospective Analysis of the Effect of Hering's Law on Outcomes of Surgical Correction of Ptosis

Pan¹,

Yu²,

Zhang³

et al. 2018

Annals of Plastic Surgery

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IntroductionSeveral factors may influence aesthetic outcomes of ptosis surgery, especially in patients with asymmetrical ptosis. We retrospectively assessed the effect of Hering's law on surgical outcomes of patients with asymmetrical ptosis.MethodsPatients with mild to moderate asymmetrical ptosis (N = 300) who underwent advancement or plication of upper eyelid aponeurosis between January 2014 and July 2016 were enrolled. Fifty patients (group A) underwent surgery without taking into consideration the impact of Hering's law. Of these, 35 patients with unilateral ptosis (subgroup A1) underwent standard surgery on the contralateral side, whereas 15 patients with bilateral ptosis (subgroup A2) were first operated on the milder side followed by the more severely affected side.In 250 patients (group B), surgery was performed taking cognizance of the implications of Hering's law. These included 100 patients with unilateral ptosis (B1) and 150 with bilateral ptosis (B2). Difference in bilateral palpebral fissure symmetry by less than 0.5 mm was considered as satisfactory outcome.ResultsDuration of postoperative follow-up ranged from 3 to 24 months. Satisfactory outcomes were achieved over 60% of patients in group A (A1, 60.6%; A2, 66.67%) and in 96% of patients in group B (B1, 95%; B2, 96.67%). Patients with unsatisfactory outcomes underwent repair according to Hering's law after 3 months and obtained good results.ConclusionsApplication of Hering's law may improve outcomes of corrective surgery in patients with asymmetric ptosis.

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Section: Discussionmentioning

confidence: 91%

Retrospective Analysis of the Effect of Hering's Law on Outcomes of Surgical Correction of Ptosis

Pan¹,

Yu²,

Zhang³

et al. 2018

Annals of Plastic Surgery

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“…Wide dissection of the OOM for harvesting the double-breasted FOOM flap required longer operative time and yielded longer downtime. 13 , 22 The function-preserving FOOM flap addresses lagophthalmos by performing submuscular dissection from the lower part of the orbital OOM, thereby leaving most OOM in situ without disturbing the integrity of the muscle.…”

Section: Discussionmentioning

confidence: 99%

“…We recommend placing the ptotic upper lid margin 1 mm below the limbus with the patient in a sitting position, and placing the upper limbus margin intraoperatively with the patient supine. 13 , 22 …”

Section: Discussionmentioning

confidence: 99%

“…The upper lid margin was adjusted to rest at 1 mm below the limbus when the patient was in a sitting position. 13 , 22 The muscular flap was then anchored to the central and upper one-third of the tarsus with 6-0 nylon sutures. The excised excess muscle was diced into several pieces and used to fill in the gap above the FOOM flap to generate a smoother contour of the upper eyelid.…”

Section: Methodsmentioning

confidence: 99%

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The Function-Preserving Frontalis Orbicularis Oculi Muscle Flap for the Correction of Severe Blepharoptosis With Poor Levator Function

Huang

Lee

Lai³

et al. 2021

Aesthetic Surgery Journal

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Background Severe blepharoptosis with poor LF has traditionally been managed with exogenous frontalis suspension but complications such as lagophthalmos, infection, rejection were often reported. Objectives The function-preserving frontalis orbicularis oculi muscle (FOOM) flap was designed to correct severe blepharoptosis with poor levator function (LF). With preservation of the OOM function, the long-term surgical outcome of the technique was assessed. Methods This retrospective study included only adult patients with severe blepharoptosis and poor LF, all of whom had their surgery performed by the senior surgeon, Lai CS, over a 6-year period. Clinical assessment of LF, palpebral fissure height (PFH), marginal reflex distance 1 (MRD1), duration of follow up, and postoperative complications were recorded. Results 34 patients and 59 eyelids were recorded during a mean follow-up period of 17.7 months. Postoperative evaluation yielded improvements of an average PFH gain of 5.62 ± 1.61 mm (p < 0.001) as well as MRD1 and PFH increase by an average of 4.03 ± 0.82 mm (p < 0.001) and 8.94 ± 0.81 mm (p < 0.001), respectively. All patients demonstrated normalization of orbicularis function as no lagophthalmos was observed at the 8-month postoperative follow up. Recurrence of ptosis were recorded in four eyelids (6.78%). Revisions were performed in two eyelids (3.39%). No infection or granuloma was noted. Conclusions The function-preserving FOOM flap is a useful vector for frontalis suspension. Not only does it effectively address lagophthalmos as well as other complications, but it provides aesthetically pleasing outcomes in patients with severe blepharoptosis and poor LF.

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“…In cases of poor levator muscle function, surgery with contraction of the frontalis is needed directly via the muscle itself or indirectly via an artificial material between the frontalis muscle and the tarsal plate. The frontalis sling technique has been considered the main procedure to treat patients with severe eyelid ptosis for decades [1][2][3][4][5][6]. Blepharoptosis correction under local anesthesia via frontalis transfer (local FT) can be an effective, but aggressive treatment [7].…”

Section: Introductionmentioning

confidence: 99%

Frontalis Transfer and Closed Silicone Rod Frontalis Suspension

Lee

Park

2016

Arch Aesthetic Plast Surg

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Background Improvements in the degree of marginal reflex distance 1 (MRD1) were compared before and after use of the frontalis transfer (FT) method and closed silicone rod frontalis suspension surgery (SS) for severe blepharoptosis under general or local anesthesia with or without minimal sedation. Methods We reviewed the medical records and photographs of 76 patients who had visited our institute between 2006 and 2013 because of severe blepharoptosis with poor levator function and treated by the same senior doctor. Results In total, 104 eyes (63 patients) were included after applying exclusion criteria; 71 eyes (44 patients) were corrected using FT, and 33 eyes (19 patients) were corrected using the frontalis sling method with a silicone rod. Among the general FT, local FT, general SS, and local SS groups, the mean preoperative MRD1 was not significantly different. Postoperative MRD1 was highest in the local FT group. Conclusions Both FT and SS positively increased MRD1, regardless of the anesthesia used; however, the change in MRD1 of the general SS group was the lowest (1.11±0.848 mm). Further, general FT, local FT, and local SS groups had an approximate 2 mm or greater increase in the differences between postoperative and preoperative MRD1. Specifically, the local FT group had a definite positive correlation with postoperative MRD1.

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The Role of Frontalis Orbicularis Oculi Muscle Flap for Correction of Blepharoptosis With Poor Levator Function

Cited by 22 publications

References 26 publications

Retrospective Analysis of the Effect of Hering's Law on Outcomes of Surgical Correction of Ptosis

Retrospective Analysis of the Effect of Hering's Law on Outcomes of Surgical Correction of Ptosis

The Function-Preserving Frontalis Orbicularis Oculi Muscle Flap for the Correction of Severe Blepharoptosis With Poor Levator Function

Frontalis Transfer and Closed Silicone Rod Frontalis Suspension

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