<h4>EXCERPT</h4> <p>The surgical management of severe congenital blepharoptosis in pediatric patients continues to evolve. Results are often less than ideal regardless of the procedure used. This accounts for the numerous reports of proposed improved techniques and modifications of frontalis suspension and maximal levator muscle resection surgical procedures. A recent improvement in the frontalis suspension procedure is the incorporation of tarsal fixation of the suspensory material. This procedure includes an eyelid crease incision with dissection to the tarsus. This technique may preclude slippage of the suspensory material and recurrence of the ptosis. Although this increases surgical time, the improved long-term results make the extra time invested well worth it.</p>