A Comparative Analysis in Frontalis Sling with and without Blepharoplasty for Aesthetic Outcome

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Objective: To compare the functional and aesthetic outcomes of isolated frontalis suspension versus a combined sling-blepharoplasty approach in patients with severe myogenic ptosis associated dermatochalasis in Hyderabad, Pakistan. Methods: A prospective cohort study was conducted at the Sindh Institute of Ophthalmology and Visual Sciences, Hyderabad, Pakistan, from July 2025 to December 2025. Patients with severe myogenic ptosis were equally allocated to isolated sling or combined sling–blepharoplasty groups. Functional outcomes marginal reflex distance 1 (MRD1), levator function) and aesthetic outcomes (grading scale, lid symmetry, crease height, visual analog scale (VAS)) were assessed, and postoperative complications were recorded. Higher MRD1, grading scores, crease height, and VAS values indicated better outcomes, while lid symmetry (≤1 mm) was considered favorable. Results: Of total 80 patients, the median age was 30 years (IQR: 23–38). Functionally, MRD1 improved significantly in both groups (p-values <0.001), with higher postoperative values in the combined group (p-value =0.006). Levator function did not improve in the isolated group but remained relatively preserved in the combined group (p-value <0.001). Aesthetically, the combined group showed significantly better outcomes, including higher median observer scores (p-values <0.001), improved lid symmetry (p-value =0.025), greater patient satisfaction (p-value <0.001), and increased eyelid crease height (p-value <0.001). Postoperative complications occurred in 19 (23.8%) patients, with no significant association between the groups (p-value =0.600). Conclusion: The combined sling–blepharoplasty approach showed superior functional and aesthetic outcomes compared to isolated sling surgery.

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