Objective To evaluate the surgical outcomes of fan-shaped frontalis fascial flap suspension for correcting congenital severe blepharoptosis. Methods A retrospective review was conducted on patients with congenital severe blepharoptosis treated with fan-shaped frontalis fascial flap suspension between January 2021 and February 2022. Results Ninety-nine patients （43 bilateral，56 unilateral；142 eyes） aged 3-15 years were followed for 6-48 months. Ninety patients achieved satisfactory results without requiring secondary surgery. Among these，30 patients exhibited immediate postoperative lagophthalmos， which resolved spontaneously within 6 months. Nine patients （3 bilateral，6 unilateral；9 eyes total） with undercorrection underwent successful secondary surgery after 6 months. Five patients developed superior fornix prolapse within 2 weeks postoperatively， which resolved with ointment application and pressure dressing. At follow-up （6 months to 4 years）， all patients with simple congenital severe blepharoptosis showed upper eyelid margins ≥1 mm above the pupillary superior margin （MRD1>2 mm）. All 6 patients with blepharophimosis syndrome exhibited upper eyelid descent to the pupillary superior margin （MRD1=2 mm） but maintained normal visual development without requiring secondary surgery. Two patients with Marcus Gunn syndrome achieved complete ptosis correction with significant reduction in jaw-winking. All patients demonstrated upper eyelid lag on down-gaze. Although mild nocturnal lagophthalmos persisted in 10 patients， all had positive Bell's phenomenon and none developed exposure keratitis. No complications such as entropion， ectropion， late exposure keratitis， or long-term sequelae were observed. Conclusion The single-eyelid crease incision approach for fan shaped frontalis fascial flap suspension provides direct surgical access without additional incisions or synthetic materials， eliminating risks of rejection. This technique is safe and effective for congenital severe blepharoptosis， including cases of Marcus Gunn syndrome and blepharophimosis syndrome.

Frontalis fascial flap, Severe ptosis, Surgical effects