Purpose

To present a video demonstration of adjustable suture eyelid surgery and highlight its value in cases where predictable eyelid height and contour are challenging, including upper eyelid retraction, complex re-do ptosis surgery, and high dehiscence ptosis.

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Methods

The video demonstrates the key surgical steps of adjustable suture ptosis repair through an anterior approach. The technique is shown in selected complex cases of upper eyelid retraction in a 57 year-old female with thyroid eye disease, and in an 81 year-old male with high dehiscence ptosis where standard ptosis repair may carry a higher risk of under-correction, overcorrection, or asymmetry. Following identification and advancement of the levator aponeurosis, Polyglactin 5-0 sutures are placed through the levator aponeurosis and tarsal plate in a manner that allows postoperative adjustment of eyelid height and contour. The sutures are fine-tuned and adjusted at one day post-operatively. The cases presented achieved satisfactory eyelid height and cosmetic outcomes.

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Results

Adjustable suture eyelid surgery allows controlled modification of upper eyelid height and contour, improving the ability to achieve symmetry in difficult cases. The technique is especially useful in patients with upper eyelid retraction, previous eyelid surgery, scarred or altered anatomy, and high levator dehiscence. It provides flexibility and a higher degree of precision when postoperative eyelid position is difficult to predict.

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Conclusion

Adjustable suture ptosis surgery is a valuable technique in the oculoplastic surgical armamentarium. By allowing fine-tuning of eyelid position, it may reduce the risk of unsatisfactory height or contour and improve outcomes in complex ptosis and eyelid retraction cases. This video aims to demonstrate practical surgical steps and decision-making points that can help surgeons apply the technique safely and effectively.

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Additional Authors

First name	Last name	Base Hospital / Institution
Agni	Mokka	University Hospitals of Leicester
Eman	Daoud	University Hospitals of Leicester
George	Papadakis	University Hospitals of Leicester
Raghavan	Sampath	University Hospitals of Leicester

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