Adjustable sutures in eyelid surgery for ptosis and lid retraction

New techniques are described and illustrated for ptosis and lid retraction surgery in which the sutures holding the upper eyelid position are adjustable postoperatively. In the anterior approach, the sutures pass from the levator muscle through the anterior surface of the tarsal plate at the position of the skin crease and are tied at the skin crease incision. In the posterior approach, the sutures pass from the levator muscle through the cut upper edge of the tarsal plate and are tied at the position of the desired skin crease. The techniques allow the lid height to be adjusted for over and undercorrection medially, centrally, laterally, or overall if required, thereby achieving the optimal surgical result without altering the position of the skin crease. Suture adjustment is a simple procedure and is recommended at 24 hours.