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Question:
I need some information on frontalis sling: When is this done and how comfortable is it? What is the success rate? What are the advantages and disadvantages of having this done?

Answer:
Frontalis slings are one surgical approach to the repair of a droopy eyelid or ptosis (TOE-sis). Ptosis occurs when the muscles that lift the eye are diseased or stretched out. The vast majority of people with ptosis develop it as adults as part of the natural aging process. In these individuals, the muscle still works, but because it has stretched out with age, the lid is lower at rest and it takes more effort to keep the lid high enough to see out your eye. Surgery to fix this condition involves tightening or shortening this muscle in order to raise the lid's resting position.

In cases where the muscle is diseased (usually children born with it or adults who develop degenerative nerve or muscle disease), not only is the lid lower, but the muscle is unable to lift the lid very much at all. People whose lid muscles are diseased in this way find that they can lift the lids somewhat by using their forehead muscle (the frontalis muscle) to lift the brows which in turn lifts the lid a little bit as well. These are the people for whom frontalis slings are a good surgical choice. A sling is a loop of material that is threaded beneath the skin between the eyebrow and the lid skin just above the lashes. When this loop is tightened, like a purse string, it makes it easier for the forehead muscle to lift the lid. The loop can be made of sutures, artificial strips, donor tendon, or even tendons obtained from the thigh of the patient him or herself!

Success of this procedure is defined by an improvement in the lid's resting position but this will depend entirely on the patient's ability and willingness to use the forehead or frontalis muscle. Without this effort, the lid will, in most cases, still look droopy. In most cases, patients who have slings performed will, at least initially, have trouble closing the lid and will have a limited spontaneous blink. It is important to keep the eye moist during this time with over the counter eye drops and moisturizing ointments. These lid movement limitations typically improve with time but when needed on only one eye, a certain amount of imbalance between the two upper lids is usually unavoidable after a sling procedure. 

People who need frontalis slings have the most complicated and severe types of droopy lids. Ophthalmologists who perform this type of complex ptosis repair typically have specialized training in plastic and reconstructive surgery of the eye, eyelids, tear system and eye socket. You can get more information by consulting with this type of oculoplastic specialist for particular answers to your individual concerns.

Answered by: Tamara R. Fountain, MDDr. Tamara Fountain

Categories: Eye Conditions, Eye Surgery

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Answered: Apr 11, 2012

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