Surgical results of retroauricular fascia graft in frontalis suspension surgery: A case series study

Abstract

Frontalis suspension surgery is commonly used for repair of congenital ptosis and involutional blepharoptosis with poor levator function. Grafts for this procedure have been developed using many a variety of different materials, each with advantages and disadvantages. The retroauricular fascia graft might be beneficial in this surgery. This article reports the surgical results of blepharoptosis, who were treated with the retroauricular fascia, which is a new autologous graft for the frontalis suspension technique. This case series study targeted patients with ptosis who underwent frontalis suspension surgery with the retroauricular fascia graft at Wakayama Medical University in Japan between May 2016 and May 2023. Patients with insufficient follow-up (<6 months) were excluded from the study. Eligible patients were categorized into one of the following three assessment groups: ‘good’ (improvement of palpebral fissure height without laterality, MRD-1Margin reflex distance-1 gap between right and left side < 0.5mm), ‘fair’ (improvement of palpebral fissure height with laterality) or ‘poor’ (poor improvement of palpebral fissure height). Thirty-five eyes in 25 patients were treated with the retroauricular fascia graft. The mean postoperative follow-up was 27 months. Eight patients were classified as good (32%), 15 as fair (60%), and two as poor (8%). Two patients (8%) had postoperative lagophthalmos. No patients had eyelash inversion, tarsal deformity or recurrence of ptosis recurrence. Scars along the edge of the hairline were inconspicuous and there were no hypertrophic scars. Functional reconstruction of the eyelids using the retroauricular fascia graft technique is described here for the first time. This graft technique may be a useful alternative for frontalis suspension surgery because it can be harvested with easy access and without leaving conspicuous scars.