The results of Fronto-Levator Adhesion Technique(FLAT)in the treatment of patiens whit other frontal suspension techniques

The aim of this study is to present the application and results of Fronto-Levator Adhesion Technique (FLAT) and its comparison with currently used frontal suspension techniques in ptosis patients with less than 4 mm of levator function. 20 ptotic patients (26 eyelid) with less than 4 mm of levator function who applied to Gaziantep University Faculty of Medicine Sahinbey Education and Research Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery betweeen March 2008 and December 2013were enrolled in this study. All of the patients underwent frontal suspension with Fronto-Levator Adhesion Technique, in which the levator muscle and its aponeurosis is tunnelized under the orbital septum. Data were collected regarding patients' age, sex, levator function, degree of ptosis, whether they were operated elsewhere, incision scars, postoperative complications, periodic photographs taken both preoperatively and postoperatively and physical examination notes were taken. Thus, the application of Fronto-Levator Adhesion Technique, its results and comparison with other available suspension techniques were conducted. In an attempt to have a homogeneous patient population, all of the patients were of congenital myogenic type and only one patient had blepharophymosis. A total of 20 patients as of 11 males (55%) and 9 females (45%) were operated. The mean age of patients was 20 and 13 of them (65%) were under 10 years. 14 of the patients (70%) had unilateral, whereas 6 (30%) had bilateral ptosis. Of the unilateral cases, 8 (40%) had ptosis of the right, 6 (30%) had ptosis of the left upper eyelid. The preoperative mean distance of 4,12 mm between upper and lower eyelid margins was found to be 8,75 mm postoperatively, hence a mean correction of 4,63 mm was obtained. In one patient, although a cosmetically acceptable result was obtained, a residual ptosis of 2,2 mm was accepted as unsuccessful. One patient had a minimal hematoma during the immediate postoperative period which was drained at the bedside. Another patient had slight lagophthalmos which resisted until 6th postoperative month and didnot require any intervention. The results in 21 eyelids of 17 patients (81%) were evaluated as successful, 4 eyelids of 2 patients (15%) were evaluated as satisfactory and 1 eyelid (4%) were evaluated as unsuccessful. We think that Fronto-Levator Adhesion Technique is a useful alternative to currently used frontal suspension techniques in patients with a levator function of 4 mm or less.