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.