Introduction: Blepharoptosis with poor levator function is commonly repaired with a frontalis suspension procedure. A variety of suspension materials have been used, including autologous fascia lata, banked fascia lata, Supramid, Gortex, silicone, and Mersilene. Autologous materials offer the advantage of less rejection and granuloma formation, and lower rates of ptosis recurrence. Autologous fascia lata, although commonly used, has been associated with hemorrhage, scar problems, pain, and muscle herniation over the harvest site. Additionally, sufficiently long autogenous fascia is sometimes not readily available. We describe the use of autologous pedal extensor (extensor digitorum longus) tendon for frontalis suspension. Materials and Methods: In a retrospective study, the authors evaluate 19 frontalis sling suspension surgeries using pedal extensor tendon in 17 consecutive patients with ptosis with poor levator function. The method of harvesting the pedal extensor tendon is described in detail. Results: Of 19 ptotic eyelids, 18 were successfully corrected with good final lid position. One eyelid was undercorrected. No recurrence of ptosis was encountered. No wound infection, eyelid contour abnormality, or ptosis overcorrection occurred. One eye developed exposure keratopathy that resolved with conservative treatment. There were no major complications associated with the pedal extensor tendon donor site. Discussion: Frontalis suspension with an autogenous pedal extensor tendon appears to be cosmetically sound and an effective treatment for ptosis with poor levator function. Its use as an alternative material to fascia lata for frontalis sling surgery can be considered.
Unilateral Versus Bilateral Frontalis Suspension Sling Surgery for Correction of Severe Unilateral Congenital Ptosis.