Combined fascial sheath CFS suspension

What is combined fascial sheath CFS suspension?

Conjoint Fascial Sheath (CFS) suspension is a surgical procedure to improve ptosis, primarily suitable for individuals with weak levator palpebrae superioris muscles or significant ptosis.

The CFS (Cervical Fiber Syndrome) is located deep within the upper eyelid and is a layer of fascia connecting the levator palpebrae superioris muscle and the superior rectus muscle. Simply put, it acts like a "support structure" that helps lift the eyelid upwards. The surgery utilizes this tissue for suspension and fixation, helping the weak upper eyelid to lift more smoothly and improving conditions such as eyelids covering the pupil, uneven eye size, difficulty opening the eyes, or frequently needing to raise the eyebrows to open the eyes.

CFS suspension is one of the methods for correcting ptosis, but it is not suitable for all types of ptosis. The appropriate surgical method should be determined by a doctor based on factors such as the degree of ptosis, the strength of the levator palpebrae superioris muscle, eye movement, and previous eye surgeries.

Applicable to

Candidates for combined fascial sheath CFS suspension surgery

Moderate to severe ptosisThe upper eyelid is positioned too low, and may even partially cover the pupil.
People with weak levator palpebrae superioris muscle functionSimply adjusting the levator palpebrae superioris muscle may not achieve the desired improvement.
Congenital ptosisFrom childhood, there has been unilateral or bilateral drooping eyelids, uneven eyes, etc.
Those who have difficulty opening their eyesWhen opening their eyes, they tend to unconsciously raise their eyebrows and use their forehead muscles for support.
People with obviously uneven eyesThe difference in the force exerted on each eye causes asymmetry in the height of the palpebral fissure.
Patients who have undergone ptosis surgery but still have drooping eyelidsIf insufficient correction or recurrent drooping occurs after surgery, it may be necessary to assess whether CFS suspension surgery is suitable.
Those who wish to balance eyelid position and eye-opening functionIt requires a comprehensive assessment by a physician based on the function of the extraocular muscles, the condition of the eyelids, and the status of eye movement.

The appropriate surgical method still needs to be comprehensively evaluated based on factors such as the degree of ptosis, levator palpebrae superioris function, eye movement, eyelid tissue condition, and whether the patient has previously undergone eye surgery. Not all ptosis is suitable for combined fascia sheath CFS suspension surgery, and a doctor still needs to evaluate and select the appropriate correction method.

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Dr. Liu Chunxi

Bachelor of Medicine, Sun Yat-sen Medical University
Master's Program in Clinical Medicine, Chang Gung University
Ophthalmology Resident Physician at Chang Gung Memorial Hospital
Researcher Training in the Department of Oculoplastic Surgery, Chang Gung Memorial Hospital
Former attending physician of oculoplastic surgery at Chang Gung Memorial Hospital
Researcher in the Department of Oculoplastic Surgery at Manhattan Eye and Ear Hospital, USA
Graduated from UCLA Facial Plastic Surgery Program
Ophthalmologists of the Republic of China

Dr. Wei-Cheng Ching

前長庚顱顏Orthognathic Surgery中心主治醫師
一二代VASER Liposuction原廠雙認證
Certification for Facelift Surgery Training in the United States, South Korea, and Japan
Japanese | Korean | Taiwanese Facial Plastic Surgery Training and Certification
Japan | South Korea | Taiwan Secondary Reconstructive Surgery Training and Certification

Dr. Hsin-Yu Chen

眼整形(雙眼皮手術、Ptosis Correction Surgery、眼袋手術等）、耳整形(招風耳手術)
視覺年輕化項目(Endoscopic Forehead Lift、法令紋澎澎術、消除頸紋、自體脂肪臉雕…）
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Frequently Asked Questions

Q: What are the differences between combined fascia sheath CFS suspension and regular levator palpebrae superioris surgery?

A: General levator palpebrae superioris surgery primarily improves ptosis by adjusting the levator palpebrae superioris muscle or related tissues; CFS suspension surgery utilizes the combined fascial sheath between the levator palpebrae superioris muscle and the superior rectus muscle for suspension and fixation. The two procedures have different applicable conditions, and the choice of surgical method depends on the function of the levator palpebrae superioris muscle and the degree of ptosis.

Q: In what situations would you consider combining CFS suspension with fascial sheath?

A: If the patient has moderate to severe ptosis, weak levator palpebrae superioris muscle function, congenital ptosis, or has undergone levator palpebrae superioris muscle surgery but still has insufficient correction or ptosis recurrence, a doctor can further evaluate whether the patient is suitable for CFS suspension surgery.

Q: Can combined fascia sheath CFS suspension surgery improve uneven eye size?

A: If the difference in eye size is mainly related to the asymmetry in the height of the two eyelids or the strength of eyelid lifting, the position of the eyelids can be adjusted through surgery; however, the difference in eye size may also be related to factors such as eyebrow height, eye socket structure, and eyeball position, so it is necessary to first determine the cause.

Preoperative/postoperative care for combined fascial sheath CFS suspension surgery

Preoperative preparation

Combined fascia sheath CFS suspension is mainly used to improve ptosis. Preoperative assessment is required, including the degree of ptosis, levator palpebrae superioris muscle function, bilateral symmetry, eye movement, and existing eye shape. If you have previously undergone double eyelid surgery, levator palpebrae superioris muscle surgery, or other eye surgeries, you should inform your doctor as this is an important reference for surgical planning.
During the consultation, it is recommended to avoid eye makeup, double eyelid tape, or double eyelid glue. It is also not recommended to wear colored contact lenses, magnifying lenses, or tinted contact lenses, as these may interfere with the doctor's observation of the original eyelid position, pupil exposure, and bilateral symmetry. If you require glasses, you can bring them with you and remove them as instructed by the doctor during the examination or evaluation.

Postoperative repair

Following combined fascial sheath CFS suspension surgery, the doctor will assess eyelid height, bilateral symmetry, and eye closure. Patients can generally return home after adequate rest and once their condition has stabilized, and follow the doctor's instructions for aftercare.
After surgery, varying degrees of swelling, bruising, and tightness may occur around the eyes. Applying ice packs as directed by medical staff in the early postoperative period is recommended. Avoid direct pressure on the eyeball and surgical wound when applying ice packs to prevent discomfort.
During recovery, keep the wound clean, avoid rubbing your eyes, pulling your eyelids, and strenuous exercise, and reduce smoking, alcohol consumption, and spicy foods. If temporary dryness, a foreign body sensation, or incomplete eye closure occurs after surgery, use artificial tears or eye ointment as directed by your doctor, and return for follow-up appointments as scheduled to monitor your recovery.