Author’s Disclosure Block: Karim Punja, Clarion Medical Technologies Employment/honoraria/consulting fees, Clarion Medical Technologies, Employment/honoraria/consulting fees; Antonio Florido, none; Michael T Kryshtalskyj, none; Carson Schell, Abbvie. Consultant

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Purpose:This study aims to share the experience of Canadian surgeons at 2 centers employing the frontalis muscle flap advancement (FMFA) technique for the correction of severe ptosis in patients with poor or absent levator function. The focus is on the surgical technique, pearls and pitfalls, as well as functional and aesthetic outcomes. Study Design: Case series. A retrospective review was conducted involving 25 patients (38 eyelids): 7 adults (9 lids) and 18 children (29 lids) who underwent frontalis flap surgery between 2023 and 2024. All patients presented with severe ptosis and poor or absent levator function, necessitating frontalis linkage. Methods: The FMFA technique was utilized to directly suspend the upper eyelid via the frontalis muscle, bypassing the non-functional levator muscle. Patients' medical records were reviewed for demographic data, surgical outcomes, and postoperative complications. The age of patients ranged from 8 months to 79 years, with underlying diagnoses including Oculopharyngeal Muscular Dystrophy (OPMD), Chronic Progressive External Ophthalmoplegia (CPEO), congenital myogenic ptosis, myotonic dystrophies and third cranial nerve palsy (CN3 palsy). Paired t-tests were used to compare MRD1s pre- and post-operatively. Approval for this case series was waived by the University of Calgary Conjoint Health Research Ethics Board. Results: The mean pre-operative MRD1 was0.05 mm(SD ±1.29 mm), increasing significantly to3.14 mm(SD ±1.32 mm) postoperatively (p<0.001). The maximum improvement was+7 mmin a 79-year-old male with CN3 palsy. Theminimum improvement was a conservative +1.5 mm, intentionally targeted in a patient with CPEO and poor Bell’s phenomenon. Minor complications included transient lagophthalmos and eyelash inversion, which was managed with tarsal everting sutures. At an average follow-up of14 months, patients maintained functional and aesthetic outcomes, confirming significant and sustained eyelid elevation post-surgery. Conclusions: The FMFA technique proves to be an effective method for correcting severe ptosis in patients with poor or absent levator function. Its ability to provide dynamic eyelid elevation and improved aesthetic outcomes makes it an enticing alternative to autologous grafts or alloplastic implants, and one that is increasingly sought after by Canadian patients. Long-term studies (e.g., years) are required to assess the longevity of this technique comapred to conventional frontalis suspension methods.
Quality of Life of GED treatments on Patients: a Systematic