Microstructure and mechanical properties of synthetic brow-suspension materials

Levator palpebrae superioris (LPS) is a muscle responsible for lifting the upper eyelid and its malfunction leads to a condition called "ptosis", resulting in disfigurement and visual impairment. Severe ptosis is generally treated with "brow-suspension" surgery, whereby the eyelid is cross-connected to the mobile tissues above the eyebrow using a cord-like material, either natural (e.g. fascia lata harvested from the patient) or a synthetic cord. Synthetic brow-suspension materials are widely used, due to not requiring the harvesting of fascia lata that can be associated with pain and donor-site complications. The mechanical properties of some commonly-used synthetic brow-suspension materials were investigated--namely, monofilament polypropylene (Prolene®), sheathed braided polyamide (Supramid Extra® II), silicone frontalis suspension rod (Visitec® Seiff frontalis suspension set), woven polyester (Mersilene® mesh), and expanded polytetrafluoroethylene (Ptose-Up). Each material underwent a single tensile loading to the failure of the material, at three different displacement rates (1, 750 and 1500 mm/min). All the materials exhibited elastic-plastic tensile stress-strain behaviour with considerable differences in elastic modulus, ultimate tensile strength, elastic limit and work of fracture. The results suggest that, as compared to other materials, the silicone brow-suspension rod (Visitec® SFSS) might be the most suitable, providing relatively long-lasting stability and desirable performance. These findings, together with other factors such as commercial availability, cost and clinical outcomes, will provide clinicians with a more rational basis for selection of brow-suspension materials.