Abstract: Abstract: Objective　To evaluate the clinical effect of a modified frontalis muscle flap suspension for severe ptosis. Methods　Two hundred and fourteen patients (285 eyes) with severe ptosis underwent a modified frontalis muscle flap suspension approach. The surgical approach was a crease incision, and a nasal vertical incision of frontal muscle flap was made on temporal side of supraorbital notch without temporal vertical incision. The subcutaneous separation of frontal muscle began at the lower edge of the eyebrow and ended at 5 mm above the eyebrow and the ventral separation ended under the upper edge of the orbit. The marginal reflex distance (MRD1), symmetry of height, contour and complications before and after surgery were compared. Results　The average follow-up period was (10.2 ± 3.1) months. The postoperative MRD1 was higher than that before operation [(3.2±0.7) mm vs. (-0.5±0.8) mm，t=58.760, P＜0.01], and the upper eyelid activity increased significantly [(11.2±1.4) mm vs. (3.5±0.8) mm，t=80.617, P＜0.01]. One hundred and ninety patients (253 eyes) achieved their desired lid height and contour, with a final success rate of 88.8%. Complications such as entropion, exposure keratitis，frontal paralysis, frontal hypoesthesia, severe hematoma were not seen in our series. Conclusion　The modified frontalis muscle suspension technique shows a high success rate with less bleeding, mild damage and fewer complications. It is a reasonable alternative treatment in severe ptosis.

Key words:  blepharoptosis, postoperative complications, frontalis muscle suspension surgery, upper eyelid activity