Autologous Tendon Sling

It is also called autologous ligament suspension of the lower eyelid. This technique is mainly indicated for patients with ocular socket indentation and moderate palpebral ectropion due to trauma or a previously failure failed lower blepharoplasty , whichand realizes stronger lower eyelid support. This surgery harvests a segment of palm fascia tendon (useless during adulthood), which, after the subcutaneous relaxation of scar adhesion via an incision at the inner and outer corners of the lower eyelid, is inserted into the subcutaneous channel and emplaced at the site of palpebral ectropion, and then is tightened and fixated at both ends to the periosteum at the inner and outer corners of the orbital bone. The tendon provides sufficient tension like a strong cable and effectively elevates the extroverted eyelid and suspends it to the parallel position of the eyelash, which radically eradicates potential recurrence or adhesion and is an ultimate solution for the treatment of refractory palpebral ectropion.

Surgical conditions


  • Type of anesthesia: IV sedation + local anesthesia
  • Surgical incision: An aApproximately 5-mm incision at the inner and outer corners of the lower eyelid
    Two incisions of approximately 5 mm at the waist (for the donor site of tendon)
  • Recovery: 7 days
  • Removal of stitches: 7–10 days

General instructions

No food and water on the day of surgery

  • Apply cosmetic gel to the lower eyelid for 2 weeks postoperatively to stabilize the surgical results.
  • Avoid smoking, alcohol, or other irritating foods for 1 month postoperatively.
  • Avoid staying up late for 3 months postoperatively, and sustain eye warm compresses till the swelling completely subsides.

Ideal candidates

  • Patients with severe eyelid drooping or palpebral ectropion
  • Those who show insignificant results after lower eyelid suspension or lateral canthopexy
  • Those with chronic conjunctivitis due to long-term palpebral ectropion
  • Those with ocular socket indentation due to lower eyelid adhesion or ectropion
  • Those with traumatic eyelid ectropion

Potential complications

  • Scar hyperplasia
  • Eye shape change
  • Eye size shrinkage

Surgical advantages

  1. A tendon sling provides robust support to the eyelids and lowers the incidence of recurrence.

  2. The sSurgical scope and tissue damage are mild, which lowers the probability of postoperative scar adhesion.

  3. The rResults are persistent and stable and are less likely to change.

Surgical drawbacks

  1. A small incision for the collection of the tendon would be left on the wrist (0.5 cm).

  2. The eEye shape or size may change after the operation.

  3. It may not be possible to completely correct the conditions of patients having eyelid defect or excess skin shortage.

Before & After

These photographs represent typical results, but not everyone who undergoes plastic surgery will achieve the same.

Autologous Tendon Sling