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

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.