The 80-odd varieties1 of ptosis operations are usually divided into four groups. These groups are classically based on (1) enhanced use of the levator muscle, (2) use of the frontalis, (3) use of the superior rectus, and (4) skin excision methods. The principles of these methods, with their advantages, disadvantages, and modifications, have been adequately described in the literature. Skin excision methods may be dismissed as neither permanent nor practical, except in cases of blepharochalasis. Use of the superior rectus risks exposure keratitis from interference with normal blinking and incomplete lid closure during sleep. Other complications which may occur include diplopia and hypotropia, arching of the lid margin, entropion and trichiasis, and excessive postoperative scarring. Use of the levator and use of the frontalis are deservedly the most popular methods.
Frontalis motion can be transmitted to the tarsal border of the lid by permanent sutures, temporary sutures forming scar
SCHIMEK RA. A New Ptosis Operation Utilizing Both Levator and Frontalis. AMA Arch Ophthalmol. 1955;54(1):92-99. doi:10.1001/archopht.1955.00930020094013