Oculoplastic surgeons should switch to frontalis flap surgery in pediatric patients
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SAN FRANCISCO — Oculoplastic surgeons should stop performing frontalis sling surgery in children and instead perform frontalis flap surgery, according to a speaker here.
“With regards to frontalis flap surgery, the reason to do it is that there is no foreign body and no extra incisions,” Richard C. Allen, MD, PhD, FACS, said at Oculofacial Plastic Surgery Subspecialty Day at the American Academy of Ophthalmology meeting.
One of the initial questions Allen had when switching to frontalis flap surgery was how to utilize the levator muscle.
“Traditionally, it’s bypassed in frontalis suspension surgery, but I think we should pay attention to it. I think it plays a role when we do frontalis suspension surgery via sling or flap,” he said.
The levator muscle provides a posterior vector of pull, which may help prevent “eyelid pop.” In addition, it can be incorporated into the closing of the lid crease incision, which will help with cosmesis by preventing lash ptosis and entropion, he said.
Allen said that he has seen positive lid crease formation and good eyelash height in children after frontalis flap surgery. He discussed one case in which a patient had esotropia in one eye and was able to switch fixation to the eye that underwent the procedure.
“This surgery is not a fad. It’s not going away,” Allen said, noting its popularity on social media.
“I think once you do it, you will stop doing slings, especially for children,” he said. “My message really, more than anything else, is to stop doing frontalis slings on children.”
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Allen RC. Frontalis flap surgery: Lid crease formation and prevention of “eyelid pop.” Presented at: American Academy of Ophthalmology meeting; Nov. 3-6, 2023; San Francisco.
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