Holding the Lid: Suspension Techniques to Prevent Lower Eyelid Ectropion—A Systematic Review

Abstract

Introduction

Lower eyelid ectropion is a challenging postoperative complication that can affect both function and aesthetics. Preventative strategies are critical, particularly in high-risk periocular and midface surgeries.

Objectives and Hypotheses

This review aims to evaluate the efficacy and variety of prophylactic suspension techniques used to prevent lower eyelid ectropion. Primary outcome: Incidence of ectropion; secondary outcomes: Technique tolerability and reported complications.

Study Design

Systematic review conducted in accordance with PRISMA guidelines.

Methods

A systematic search was performed through June 2025 using keywords: “Frost suture,” “suspension,” “ectropion,” “tape,” and “prevention.” Sixteen studies were included (9 clinical, 8 technical). Data on patient indications, techniques, outcomes, and follow-up were extracted.

Results

Techniques included Frost sutures, periosteal anchoring, barbed sutures, external splinting, and forehead hitch. Ectropion prevention was generally successful, though one clinical study reported no significant benefit with Frost suture use.

Conclusions

Multiple prophylactic strategies appear effective, but evidence quality is low. Higher-level comparative studies are needed.

Keywords

lower eyelid ectropion - prophylactic suspension techniques - frost suture - barbed suture - periosteal anchoring

Declaration of GenAI Use

During the preparation of this article, the authors used ChatGPT to improve language. After using this tool/service, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.

Publication History

Received: 06 July 2025

Accepted: 04 September 2025

Accepted Manuscript online:
04 September 2025

Article published online:
10 September 2025

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