“Frontalis suspension through infrabrow skin excision for blepharoptosis in Asians.”

Summary: Frontalis suspension is the preferred approach for blepharoptosis with compromised levator function. Various studies have explored the utilization of different materials or material shapes for performing this procedure; however, only a limited number discuss the specifics of skin incisions. Given that blepharoplasty demands not only functional but also aesthetic results, we applied an infrabrow incision, a technique commonly utilized in cosmetic surgeries. This study is the first report involving a series of nine blepharoptosis cases treated using this technique and explores its viability as a promising alternative to traditional frontalis suspension. This innovative technique was employed in seven consecutive patients exhibiting poor levator function who were treated at the University of Tokyo between September 2019 and February 2022. A retrospective analysis was conducted on clinical photographs and charts. In one representative case, visual field angle and frontal muscle tone were also measured. The average duration of postoperative follow-up was 9 months. In all cases, the frontalis muscle was adequately exposed enough to allow suspension through the infrabrow approach. Notably, significant improvements were observed in the marginal reflex distances without effort from -1.9 to 2.1 mm (p = 0.0027) and marginal reflex distances with effort from 0.0 to 5.4 mm (p < 0.0001). Complications included a hematoma (n = 1), eyelash entropion (n = 1), transient sensory loss of the forehead (n = 1), and transient dry eye (n = 3). The infrabrow incision is a good alternative for frontalis suspension owing to its capacity to offer a broad surgical field, effective access to the frontalis muscle, and the ability to facilitate excess skin excisions without resulting in conspicuous scarring.