Incision-less frontalis suspension

Frontalis suspensions with alloplastic slings are well established.1,2 The thick eyebrow skin of infants is prone to scar formation. Forehead scars caused by frontalis suspension procedures can be problematic. We describe a technique of congenital ptosis surgery that avoids eyebrow incisions. This new procedure utilises a Nylon monofilament suture for frontalis suspension. The Nylon suture is passed in a circlage fashion via puncture wounds without making eyebrow incisions. Two puncture sites, approximately 10 mm apart, are marked 3 mm above the lash line centred over the area of desired maximal eyelid elevation. Another two puncture sites are marked above the eyebrow approximately in line with the lateral and medial canthi. The path of the circlage is marked out by joining the marked puncture sites. The eyelid and eyebrow are infiltrated with local anaesthetic with adrenaline (epinephrine). A Keith needle is dual threaded with a 4/0 …