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Purpose: To report 7 patients with paradoxical use of the frontalis muscle des pite postsurgical correction of ptosis with good postoperative eyelid position. Successful treatment with botulinumA toxin facilitated motor relearning and cess ation of muscle contraction. Design: Interventional case series. Participants: S even patients, in 2 eye-plastic clinics, who underwent successful surgical corr ection of upper eyelid ptosis. Methods: Review of clinical history, clinical pho tographs, treatment, and follow-up. Main Outcome Measures: Frontalis muscle con traction and upper eyelid position. Results: Patients underwent successful surgi cal correction of ptosis but continued using the frontalis muscle despite good e yelid position postoperatively. Frontalis contraction ceased spontaneously in 2 patients, but required botulinum A toxin injection in 5. The effects of a single treatment of botulinum A toxin lasted from 3 months to 2 years, longer than the expected effect of the toxin. Conclusion: Patients with long-standing eyelid p tosis may paradoxically continue utilizing the frontalis after successful surgic al correction and despite good postoperative eyelid position. Cessation of front alis contraction can be achieved with a single injection of botulinum A toxin. W e hypothesize that chemodenervation, achieved with the toxin, may influence the central nervous system to relearn the set point for muscle contraction and may b e associated with permanent motor relearning. Spontaneous resolution of muscle c ontraction can occur in the first months after surgery.
Purpose: To report 7 patients with paradoxical use of the frontalis muscle des pite postsurgical correction of ptosis with good postoperative eyelid position. Successful treatment with botulinum A toxin facilitated motor relearning and cessation of muscle contraction. Design: Interventional case series. Participants: S even patients, in 2 eye-plastic clinics, who underwent successful surgical corr ection of upper eyelid ptosis. Methods: Review of clinical history, clinical pho tographs, treatment, and follow-up. Main Outcome Measures: Frontalis muscle con traction and upper eyelid position Results: Patients underwent successful surgi cal correction of ptosis but continued using the frontalis muscle despite good e yelid position postoperatively. Frontalis contraction ceased spontaneously in 2 patients, but required botulinum A toxin injection in 5. The effects of a single treatment of botulinum A toxin lasted from 3 months to 2 years, longer than the expected effect of the toxin. Concl usion: Patients with long-standing eyelid p tosis may paradoxically continue utilizing the frontalis after successful surgic al correction and despite good postoperative eyelid position. Cessation of front alis contraction can be achieved with a single injection of botulinum A toxin. W e hypothesize that chemodenervation , with the toxin, may influence the central nervous system to relearn the set point for muscle contraction and may be associated with permanent motor relearning. Spontaneous resolution of muscle c ontraction can occur in the first months after surgery.