New adjustable suture technique for managing eyelid ptosis

The challenge of accurately predicting eyelid height after levator surgery for ptosis is a well-known problem even in competent hands. It is always better to correct an unfavorable postoperative result without surgical intervention, and thus spare the patient another involved procedure. The author describes a new adjustable suture technique that ensures a secure connection between the levator muscle and the tarsus, and allows easy postoperative adjustment of lid height. The suture design consists of an inner and an outer loop in a configuration that resembles a paper clip. When the suture is tightened, the inner loop approximates the distal part of the levator muscle to the tarsal plate, bringing the tissues into secure contact. When tightened further, the outer loop is activated and it approximates the more proximal part of the levator muscle to the tarsus as much as desired to achieve the proper eyelid height. When the sutures are tightened, the levator muscle shortens by folding on itself like the pleats of an accordion. Using this method, muscle slack is reduced as the tissue is folded on itself several times.