Introduction: The frontalis sling procedure is a time-honored treatment for blepharoptosis associated with poor levator function. It was introduced by Payr & Wright then was popularized by Crawford. The classic closed frontalis sling procedure and the modified open approach were proposed. In the modified open approach – as opposed to the classic closed approach – the sling material is directly sutured to the tarsus through a lid crease incision.Purpose: To record objectively the outcome of selected important features following the classic closed sling approach on one hand and the modified open sling approach on the other. The prospective postoperative information will allow a fair comparisonbetween the outcomes of the two approaches, which can serve as a guide in the continuous search of determining the procedure of choice.Material and Method: Forty lids with poor levator function ptosis were subjected to the proposed frontalis sling procedure 20 lids using closed approach and 20 lids using an open approach with internal fixation & Gor-Tex material. Follow up was about 3 months.Result: All cases showed functional improvement with an averageincrease of 2.5 mm in palpebral fissure measurements. Regression of results was documented up to 3 months postoperatively, after which lid height seemed to stabilize. A part from a late postoperative infection developing in 1 case, no cases of additional infection, slippage, and extrusion or granuloma formation were encountered.Conclusion: the modified open sling approach was more predictable with superior sling and cosmetic effects over the classic closed approach. However, a longer follow up and perhaps a larger number of cases may be needed to provide additional support to the findings of this study.