To the Editor.
—I thank the authors of "The Septal Pulley in Frontalis Suspension"1 for reviving the concepts presented by Hildreth and me2 in 1970. As mentioned by Patrinely and Anderson, this material was first introduced by Hildreth3 in 1937 in an article on the use of oxtail fascia as a suspensory material for frontalis suspension.As I understand Patrinely and Anderson's description of the operation, they failed to recognize one of the major concepts originally described by us. The suspensory material is passed from below in an upward direction anterior to the levator aponeurosis to the orbital roof, then dragged forward (away from the globe) to snare the arcus marginalis, creating the periosteal pulley. In doing this, especially with a lid plate in the upper cul-de-sac, it is virtually impossible to damage the globe. If the suspensory material is passed from above downward as described by
Silver B. Variation in Technique for Frontalis Suspension. Arch Ophthalmol. 1987;105(4):456. doi:10.1001/archopht.1987.01060040026009