Histologic Comparison of Upper Blepharoplasty Skin Excision Using Scalpel Incision Versus Microdissection Electrocautery Needle Tip Versus Continuous Wave CO2 Laser.

BACKGROUND: The various techniques of upper blepharoplasty have been compared based on surgical time to perform the procedure, postoperative healing, scar cosmesis, and cost. Few studies have evaluated the histology of the excised tissue, and no study has compared the tissue histology of 3 blepharoplasty methods using scalpel, microdissection needle with electrocautery, and CO2 laser excision in the same patient. OBJECTIVE: To evaluate the histologic changes of tissue after removal of upper eyelid skin using scalpel incision, microdissection electrocautery needle, and CO2 laser. METHODS: Upper blepharoplasty skin excisions were examined from specimens obtained using scalpel incision, microdissection needle tip with electrocautery, and CO2 continuous wave beam. The specimens were sent for permanent sections for histologic evaluation. RESULTS: The skin that was removed using cold steel scalpel incision showed no cellular necrosis or heat artifact. The tissue treated with the CO2 laser demonstrated significant thermal injury, including loss of cellular polarity, keratinocyte necrosis, and separation of the epidermis from the basement membrane. The skin excised using the electrocautery microdissection needle demonstrated fulguration artifact, including spindling of the epidermal nuclei with palisading of the keratinocytes. Necrosis was not prominent in the electrocautery microdissection needle specimens. CONCLUSION: The amount of histologic tissue injury was greatest in the skin treated with continuous wave CO2 laser, followed by the microdissection needle with electrocautery. The cold steel scalpel incision showed no cellular necrosis.

Upper Blepharoplasty with Endoscopically Assisted Brow Lift to Restore Harmonious Upper Lid Arc Curvatures.

BACKGROUND: Achieving excellent results in upper lid rejuvenation requires a balanced approach to address skin, muscle, fat, upper lid margin position, and brow aging changes. In the appropriately selected patient, brow lifting plays an essential complement to upper blepharoplasty to restore more youthful upper lid fold-to-pretarsal ratios. The goal of this study is to describe a safe and reproducible method to perform brow lifting and upper blepharoplasty. METHODS: Medial to the temporal line of fusion, in-line with the brow peak, a 2-cm scalp incision is oriented parallel to the course of the deep branch of the supraorbital nerve to minimize the risk of nerve injury. The brow vector of pull is maximal in this location and secured to a monocortical bone channel with 3-0 polydioxanone. Lateral to the temporal line of fusion, an ellipse of scalp tissue is excised to gently elevate the brow tail. Upper blepharoplasty is performed in an individualized fashion to achieve a youthful contour of the upper lid fold. RESULTS: The endoscopically assisted technique is designed to achieve tissue release under direct visualization. The brow-lift maximal vector of pull is centered over the brow peak and, to a lesser extent, at the brow tail to improve lateral upper lid fold height and a smooth contour of the pretarsal space. Muscle shaping sutures improve convexity of the lateral upper lid fold. CONCLUSION: In the appropriately selected patient, combined brow lift and upper blepharoplasty with muscle contouring are safe and effective techniques that help improve aesthetic upper lid topographic proportions.

[Treatment of congenital ptosis in a low-income country: polypropylene frontalis sling at the African Institute of Tropical Ophthalmology]. / Traitement du ptosis congénital dans un pays à faible revenu : suspension du releveur au muscle frontal par le polypropylène à l'Institut d'Ophtalmologie tropicale de l'Afrique (IOTA).

INTRODUCTION: Treatment of congenital ptosis is exclusively surgical; the frontalis sling method is most appropriate when the ptosis is severe, with no upper eyelid levator function. This surgery typically utilizes various materials (autologous fascia lata, silicone, nylon, or polypropylene bands, etc.). MATERIALS AND METHODS: This was a retrospective descriptive study of 22 children under 16 years of age, treated for congenital ptosis by frontalis suspension of the levator muscle of the upper eyelid using the polypropylene technique, between January 1, 2014 and June 30, 2017 at the African Institute of Tropical Ophthalmology teaching hospital. RESULTS: In our study, the surgical result (prior to correction of recurrences) was satisfactory in 81.82 % of cases, with a recurrence rate of 13.64 %. The mean follow-up was 14 months, ranging from 4 to 25 months. DISCUSSION: The use of polypropylene provides encouraging results in ptosis surgery, while also offering the advantage of being low cost and more available. Its use in developing countries deserves special attention.

The Outcomes Assessment of the Plasma Blade Technology in Upper Blepharoplasties: A Prospective Study on a Series of 25 Patients.

BACKGROUND: The Dermo Ablation Surgery (DAS) Medical® (Technolux, Italy) device is a plasma blade which induces a plasma voltaic arc causing a retraction in the epidermis and superficial dermis. OBJECTIVE: The aim of our study is to prove the efficacy and safety of the DAS Medical® device in dermatochalasis size reduction. METHODS: Our prospective study included 25 adult patients presenting with upper eyelid dermatochalasis undergoing a two-session treatment protocol with the DAS Medical® device (with a month treatment-free interval). The primary end point was the reduction in the size of the dermatochalasis. The secondary end points were patient satisfaction, and a blinded assessment of the outcomes was carried out by 15 plastic surgery specialists on post-procedural pictures. RESULTS: The mean reduction in the size of the dermatochalasis was estimated at 2.47 mm on a 6-month follow-up (13.5 mm at T0 vs. 11.03 mm at 6 months, p = 0.0002) and 1.97 mm on a 12-month follow-up ((13.5 mm at T0 vs. 11.53 mm at 12 months, p = 0.0055). Eighty per cent of the patients and 78% of the assessing clinicians were globally satisfied with the results on a 12-month follow-up. The mean visual analogue pain score reported during the treatment was 4.5/10; MEOPA® was used in 23% of cases. No irreversible post-procedural sequelae (complications) were observed. CONCLUSION: Voltaic plasma arc treatment with DAS Medical® is an effective technique for non-invasive blepharoplasty on moderate dermatochalasis patients not suffering from palpebral lipoptosis and is very well tolerated. It can be usefully and successfully associated with surgery. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Lower eyelid retractor (white-line) advancement to correct tarsal ectropion.

OBJECTIVE: To describe a modification of trans-conjunctival, lower eyelid retractor advancement to correct tarsal ectropion. DESIGN: A retrospective case review. PARTICIPANTS: Consecutive patients with lower eyelid tarsal ectropion. METHODS: Cases of lower eyelid tarsal ectropion, surgically corrected by advancement of inferior retractor to the lower border of tarsus via a transconjunctival approach, were identified. Lateral tarsal strip was also performed simultaneously in all cases. RESULTS: Twenty patients (25 eyelids) were included in this study. There were 19 primary lower eyelid tarsal ectropion and 6 recurrent tarsal ectropion. Complete resolution of tarsal ectropion was achieved in all patients postoperatively. Mean follow-up was 8.4 months (range 1-36 months). There were no cases of overcorrection, recurrent ectropion, suture abscess, wound dehiscence, or inferior fornix shortening after surgery. CONCLUSIONS: Visualization of the lower eyelid retractor (white-line) and advancement to the inferior border of tarsus through a transconjunctival approach is effective in correcting both primary and recurrent cases of tarsal ectropion. This can be performed through a small conjunctival incision in the middle third of the lower eyelid, without the need for any excision of tissue or suture loop tie on the skin surface.

Three Simple Steps for Refining Transcutaneous Lower Blepharoplasty for Aging Eyelids: The Indispensability of Micro-Autologous Fat Transplantation.

BACKGROUND: Lower blepharoplasty has been used for rejuvenating lower eyelids, and diverse modifications have been used to treat conjunct deformities at the tear trough/lid-cheek junction. Strategies for recontouring prominent tear trough/lid-cheek junctions, including orbital fat manipulation, have been reported with good results in the literature. Micro-autologous fat transplantation (MAFT) is a previously unevaluated, potentially advantageous approach to blending the prominent tear trough/lid-cheek junction. OBJECTIVES: We determined the long-term results after 3-step transcutaneous lower blepharoplasty with MAFT for patients with aging eyelids and prominent tear trough/lid-cheek junctions. METHODS: We evaluated 205 patients with aging lower eyelids who underwent transcutaneous lower blepharoplasty with MAFT between October 2010 and September 2016. The 3-step procedure involved a subciliary elliptical skin excision, resection of 3 orbital fat compartments, and MAFT for the tear trough/lid-cheek junction employing a MAFT-GUN under intravenous anesthesia. RESULTS: The mean patient age was 52 years (range, 34-78 years). The mean operating time was 61 minutes. The mean fat volumes delivered to the tear trough/lid-cheek junctions were 2.80 mL and 2.76 mL for the left and right sides, respectively. The average weights of the 3 resected orbital fat compartments were 0.58 g for the left side and 0.56 g for the right side. Patients showed significant improvement and maintenance at an average follow-up of 60.2 months (range, 18-90 months). CONCLUSIONS: Three-step transcutaneous lower blepharoplasty with MAFT is an effective, reliable, and promising method with high patient satisfaction and minimal risk of complications. Long-term results demonstrated its utility for aging lower eyelid treatment.

Refinements in Upper Blepharoplasty: The Five-Step Technique.

Periorbital tissues are a keystone in facial beauty and a representation of youth. The aesthetically pleasing and youthful upper eyelids are full, with a defined tarsal upper lid crease and with smooth, taut pretarsal and preseptal skin. The upper blepharoplasty is a critical component of any facial rejuvenation procedure. This five-step procedure provides key steps in the correction of upper lid age-related changes and provides a reliable and reproducible method of achieving excellent results. Furthermore, the addition of fractionated fat restores volume and youthfulness of the upper lid, and also improves the skin quality of the upper lid.

Quantifying Lateral Frontal Sinus Access: The Upper Blepharoplasty Approach.

OBJECTIVE: Despite advances in technology and instrumentation, access to the lateral frontal sinus remains a challenge for surgeons. We sought to quantify the reach and applicability of the upper blepharoplasty approach (UBA) to the frontal sinus. METHODS: Twelve cadaveric specimens were obtained for anatomic research and frontal sinuses divided into 3 zones. Zone 1 was defined as medial to the supraorbital neurovascular bundle (SON). The remaining orbit was then bisected to define zone 2 (centrally) and zone 3 (laterally). Twenty-four UBAs were performed followed by 12 modified endoscopic Lothrop procedures (MELP). The ability to instrument each wall of the frontal sinus was recorded for the MELP, UBA, and combined approach. RESULTS: The UBA provided excellent access to the lateral frontal sinus in zones 2 and 3 (89% and 100%). The MELP provided poorer access in zone 3 (67%) but improved access in zone 1 (83%-100%). Access for zone 1 through the UBA was limited. The combined approach yielded 100% access to each frontal sinus boundary. CONCLUSION: The MELP in combination with the UBA/lateral trephination provides excellent access to each frontal sinus boundary. The UBA provides excellent access to the lateral frontal sinus but is limited medially by the SON.

Modified Levator Muscle Resection Using Putterman Muller's Muscle-Conjunctival Resection-Ptosis Clamp.

BACKGROUND: The traditional technique for levator muscle resection includes a time-consuming dissection procedure that causes tissue trauma and swelling. The Putterman ptosis clamp has been popularly used in recent years for conjunctival müllerectomy. In this paper, we describe a modified surgical technique for ptosis treatment using the Putterman ptosis clamp. The modified technique improves the surgical results of levator muscle resection. OBJECTIVES: We performed a retrospective case-series study to determine the outcomes and complications associated with the use of the Putterman ptosis clamp in levator muscle resection. METHODS: Adults aged ≥18 years with moderate-to-severe ptosis underwent the modified technique for levator muscle resection. We first performed dissection to expose the aponeurosis and tarsus. Then, we placed the Putterman ptosis clamp to measure redundant aponeurotic and septal tissues and to perform the resection. Following the adjustment of the eyelid fissure, we refixed the levator muscle to the tarsus with 4-0 vicryl stitches. RESULTS: Seventeen patients (34 eyes) were included in the study. Of the 34 eyes, 31 (91.2%) experienced the complete resolution of ptosis after the surgery. One patient (2 eyes, 5.9%) had mild bilateral dermatochalasis and received revision surgery 6 months postoperative. One patient (1 eye, 2.9%) lost the crease of the left eye and received revision surgeries 2 and 6 months after the first surgery. No residual ptosis or severe adverse events were noted in the patients. CONCLUSIONS: Modified levator muscle resection using the Putterman ptosis clamp is an effective procedure for ptosis treatment.

Levator Aponeurosis and Muller Muscle Plication Reinforced With Levator Sheath Advancement for Blepharoptosis Correction.

The authors innovated the levator aponeurosis and Muller muscle plication reinforced with levator sheath advancement (AMPSA) for blepharoptosis correction. The orbital septum was opened 1 mm above its fusion with the levator aponeurosis. The preaponeurotic fat was retracted and the thickened part of the levator sheath was identified. Two plication sutures were made: medial suture at the medial border of the pupil and lateral between the lateral border of the pupil and the lateral limbus. A needle with 6-0 nylon thread first bit the tarsal plate approximately 1 mm below its upper border, then bit the levator aponeurosis and the Muller muscle together at 3 to 6 mm above the upper border of the tarsal plate. The needle bit 1 to 3 mm of the thickened part of the levator sheath and the suture was tied. A total of 116 eyes were operated on using levator aponeurosis and Muller muscle plication (AMP), and 79 eyes using AMPSA. The mean follow-up period was 11.4 months. In the AMP group, the postoperative marginal reflex distance-1 (MRD-1) (3.8 ±â€Š0.2 mm) was significantly greater than the preoperative MRD-1 (2.7 ±â€Š0.3 mm) (P < 0.001). In the AMPSA group, the postoperative MRD-1 (3.5 ±â€Š0.3 mm) was also significantly greater than the preoperative MRD-1 (1.7 ±â€Š0.4 mm) (P < 0.001). The improvement in MRD-1 was greater in the AMPSA group (1.7 ±â€Š0.4 mm) than in the AMP group (1.1 ±â€Š0.3 mm) (P < 0.001). The difference in the MRD-1 outcome between AMPSA and AMP (0.6 mm) was obtained by advancing the thickened part of the levator sheath. AMPSA may be an effective procedure for correcting blepharoptosis.

Asymmetry of Preoperative Incision Design Markings for Upper Blepharoplasty.

PURPOSE: To compare preoperative incision design markings between both eyelids in upper blepharoplasty. METHODS: This retrospective study examined 22 patients who underwent bilateral upper blepharoplasty surgery resulting from senile dermatochalasis and/or blepharoptosis. The initial preoperative incision design markings were drawn with the patient sitting upright. Then, with the patient in a supine position, preoperative design photographs were taken. The authors measured medial canthal excision angle, maximal lid excision height, maximal lid excision width, peak point angle, and peak point distance and compared measurements between both upper eyelids designs using Image J software. RESULTS: The mean medial canthal excision angle, maximal lid excision height, and maximal lid excision width for the right side (30.68°â€Š±â€Š10.16°, 1.17 ±â€Š0.24 cm, and 0.72 ±â€Š0.19 cm) were significantly different from those for the left side (35.39°â€Š±â€Š13.82°; P < 0.001, 1.24 ±â€Š0.25 cm; P = 0.002, and 0.77 ±â€Š0.21 cm; P = 0.011). The mean peak point angle and peak point distance for the right side (15.67°â€Š±â€Š5.09°, 2.41°â€Š±â€Š0.31°) were significantly different from those for the left side (18.11°â€Š±â€Š5.49°; P = 0.001, 2.22 ±â€Š0.28 cm; P = 0.001). CONCLUSIONS: In upper blepharoplasty, the preoperative incision marking design measurements of the left side were significantly greater than those of the right side. The symmetry can therefore be maximized by including the asymmetries in the preoperative design.

Blepharoplasty markers: comparison of ink drying time and ink spread.

Marking of the eyelid is a crucial presurgical step in blepharoplasty. A number of markers are available for this purpose with variable ink characteristics. In this study, we measured the ink drying time and spread width of 13 markers used for preoperative marking for blepharoplasty. Based on the results, we propose markers that may be best suited for use in this procedure.

[Surgery of Lower Eyelid Ectropion with the Tarsal Strip Procedure, Using Absorbable or Non-Absorbable Sutures for Periosteal Fixation]. / Operative Unterlidektropiumkorrektur ­ Tarsalzungenplastik mit resorbierbarem oder nicht resorbierbarem Nahtmaterial.

Purpose Tightening of the lower eyelid is often performed and many techniques are available. This paper describes the outcome of lower eyelid ectropion repair using the lateral tarsal strip procedure. Periosteal fixation of the tarsal strip can be performed with absorbable or non-absorbable sutures. This study compares the surgical results of periosteal fixation of the tarsal strip with a) absorbable and b) non-absorbable suture. Methods Of 206 patients who underwent surgery, data from 161 were available. During the 6 month follow-up period, suture material, recurrence rates and complications were assessed. The analysis was based on photo documentation, surgery reports and patient statements. In all cases surgery was performed by the same surgeon. Results After 6 months, patients showed similar recurrence rates, regardless of whether periosteal fixation of the tarsal strip had been performed with absorbable (61 patients) or non-absorbable (100 patients) material. Only a few complications occurred, including wound healing problems and one allergic reaction in the non-absorbable group. Conclusions In cases of lower eyelid ectropion, the surgical outcome after the tarsal strip procedure was similar for absorbable and non-absorbable sutures.

[A modified implant for upper eyelid ptosis correction in frontalis suspension surgery]. / Primenenie modifitsirovannogo implantata dlia ustraneniia ptoza verkhnego veka podveshivaniem.

AIM: to develop a modified implant to correct ptosis through brow suspension and to evaluate its effectiveness. MATERIAL AND METHODS: The clinical group consisted of 20 patients (29 eyes) aged 23 to 69 years (45±5.3 years on the average) and the comparison group - of 20 patients (33 eyes) aged 19 to 77 years (47±9.5 years on the average). All patients were operated on for severe ptosis of the upper eyelid, which implied stitching their eyelids to the eyebrows. In the main group, an original implant was introduced as suspensory material - a 200 µm thick porous polytetrafluoroethylene tape, length 13 cm, width 6 mm, round staggered perforation pattern, 1.5 mm holes, 3.5 mm pitch. In the comparison group, Mersilene mesh strips were used. The article contains a detailed description of the surgical technique. Checkups were performed at 1, 6, and 12 months. Follow-up periods were up to 4 years (1.7 years on the average) in the main group and up to 7 years (5.1 years on the average) - in the controls. RESULTS: Were evaluated by the width of the palpebral fissure at raised eyebrows, marginal reflex distance (MRD, which is the distance between the center of the pupil and the upper eyelid margin), presence and depth of the upper eyelid crease, and residual lagophthalmos. Examinations held at months 1, 6, and 12 after surgery showed that the results were positive and stable in all cases. Neither signs of recurrence, nor statistically significant differences between the groups were found. CONCLUSION: The use of the original modified implant during frontalis suspension surgery provides high and stable cosmetic result and expands the possibilities of ophthalmic plastic surgery.

Surgical Microanatomy of Lower Eyelid Tarsal Ectropion Repair With a Putterman Ptosis Clamp.

PURPOSE: To examine the changes in microscopic anatomy of the lower eyelid tarsal ectropion repair with the Putterman ptosis clamp and better understand the anatomical changes associated with the eyelid malposition correction. METHODS: Ten orbits from 5 fresh frozen cadaver heads, ranging in age from 53 to 77 years, were used for the dissection. For each head, a Putterman clamp tarsal ectropion repair was performed on one side, while the contralateral unoperated orbit served as a control. After performing the procedure, both orbits were exenterated and they, along with the resected specimens, were studied microscopically using Verhoeff-Masson trichrome and hematoxylin-eosin stains. RESULTS: Conjunctiva, capsulopalpebral fascia, and smooth muscle were present on all tissue specimens incarcerated within the ptosis clamp. Tarsus was present in one specimen. There was a shortening of the posterior lamella of the eyelid with advancement of the capsulopalpebral fascia on all operated specimens when compared with controls. CONCLUSION: The Putterman clamp ectropion repair works by shortening the posterior lamella of the eyelid and advancing the lower eyelid retractors superiorly. This advancement tightens the lower eyelid retractors and thus stabilizes the eyelid in a more vertical position. In addition to a lateral tendon tuck as described in the original article to tighten horizontal eyelid laxity, this procedure addresses both vertical and horizontal laxity of tarsal ectropion.

[Gold weight implants for lagophthalmos correction in chronic facial nerve paralysis (late results)].

UNLABELLED: Upper eyelid weigh gold implant is the widely accepted standard for the treatment of paralytic lagophthalmos (PL). AIM: To evaluate late outcomes of PL correction with chain gold implants. MATERIAL AND METHODS: Chain gold implants were inserted in the upper eyelids of 70 patients with lagophthalmos due to chronic facial paralysis. A comprehensive ophthalmic examination was performed prior to surgery and then at months 1, 3, 6, 12, 24, and 36. RESULTS: The results obtained prove the method highly effective. None of the patients developed any severe complications. Cases of implant removal were few. Some of the studied biometric parameters decreased significantly after surgery, while the upper eyelid excursion increased. The implant had no effect on the inner surface of the cornea and its peripheral thickness. CONCLUSION: Efficacy of the proposed eyelid implant has been convincingly demonstrated; late complications have been analyzed.

State of the Art in Congenital Eyelid Deformity Management.

The eyelids are crucial in maintaining the health of the ocular surface and have an important role in facial aesthetics. Interruption in eyelid development can lead to congenital eyelid deformities. This article reviews eyelid anatomy, the most common congenital eyelid abnormalities such as congenital ptosis, eyelid coloboma, and epiblepharon, and the management of these conditions.

Frontalis sling surgery: do we really need the Wright needle? / Suspensão ao músculo frontal: realmente precisamos da agulha de Wright?

ABSTRACT Purpose: The aim of this study is to describe a variation in technique of the frontalis sling surgery with silicone rods and its results, using an alternative needle with similar effectiveness to the Wright needle at a reduced cost. Methods: This was a prospective, interventional, noncomparative study of patients with severe ptosis who underwent surgical correction using a simple and modified frontalis sling surgery technique. Patients were included in this study from January 2012 to January 2014. 23 surgeries were performed on 15 patients. The minimum "follow-up" was 12 months. Results: Most patients had congenital ptosis (86%) and the average preoperative margin reflex distance 1 (MRD1) was -1.1 mm (range -3 to 0 mm). 1 week post-operation, this was 2.7 mm ( 1.8 to 3.8 mm), 1.8 mm after 1 month and 1.7 mm (1 to 2.5 mm) after one year. The satisfaction rate was 80% (12 patients). Among the dissatisfied patients, one had extrusion and infection with subsequent explantation of the wire, one had asymmetry greater than 2 mm and one had persistent lagophthalmos and punctate keratitis, with subsequent explantation of silicone. Conclusion: The use of silicone rods with tarsal fixation using an alternative needle was effective in the treatment of severe ptosis with few complication rates, a low rate of dissatisfaction and good stability of the results in the follow-up period.

RESUMO Objetivos: O objetivo deste estudo é descrever uma variação da técnica cirúrgica da suspensão ao músculo frontal com fio de silicone e seus resultados, utilizando uma agulha alternativa à agulha de Wright, com a mesma eficácia e melhor razão custo-benefício. Métodos: Foram analisados prospectivamente todos os casos de blefaroptose severa submetidos à correção cirúrgica, utilizando a técnica de suspensão ao músculo frontal modificada, no período de janeiro de 2012 à janeiro de 2014. Foram realizadas 23 cirurgias em 15 pacientes. O "follow-up" mínimo foi de 12 meses. Resultados: A grande maioria dos pacientes apresentavam blefaroptose congênita (86%), a média da distância margem reflexo pré-operatória foi de -1,1mm (-3 a 0 mm), no pós-operatório de 1 semana foi de 2,7 mm (1,8 a 3,8 mm), após 1 mês foi de 1,8 mm e após 1 ano, de 1,7mm (1 a 2,5 mm). O índice de satisfação foi de 80% (12 pacientes). Dos 3 pacientes insatisfeitos, 1 teve extrusão e infecção com posterior explante do fio, 1 apresentou assimetria maior que 2mm e 1 evoluiu com lagoftalmo persistente e ceratite puntacta, com posterior explante do silicone. Conclusão: O uso do fio de silicone com fixação tarsal usando uma agulha alternativa, se mostrou eficaz no tratamento da blefaroptose severa, com poucas complicações, baixo índice de insatisfação e boa estabilidade dos resultados no período de seguimento.

Results and complications of silicone frontalis sling surgery for ptosis.

PURPOSE: Frontalis suspension is the treatment of choice for severe blepharoptosis with poor levator function. Several materials are available for this purpose. Autologous fascia lata is considered best among naturally occurring materials; however, it may not be possible to harvest fascia lata in young children. Among various synthetic materials, silicone has been used frequently and has given good results. METHODS: This is a retrospective analysis of patients operated on from September 2008 to August 2013. All of these patients underwent silicone rod frontalis suspension for severe blepharoptosis with poor levator function and completed a minimum of 6 months of follow-up. RESULTS: There were 38 eyes of 25 patients with ages ranging from 3 to 21 years (average: 10.68 ± 6.26 years). Of these 25 patients, 10 had blepharophimosis syndrome, 10 had congenital ptosis, 3 had third nerve palsy, 1 had double elevator palsy, and 1 had post-levator resection. Good cosmetic correction was achieved in 34 eyes (89.4%) after a mean follow-up of 18 months (range: 6 to 60 months). Complications observed included significant eyelid lag and lagophthalmos (5 eyes), undercorrection (4 eyes), suture granuloma (3 eyes), sling exposure at forehead incision (3 eyes), bilateral chronic eyelid edema (1 patient), and late recurrence of ptosis (1 eye). CONCLUSIONS: Silicone is a safe material for frontalis suspension in patients with severe ptosis; however, recurrence, granuloma formation, sling exposure, and chronic inflammation can occur with use of silicone rod.