Step 11 Suspensory Suture for Lower Eyelid

One problem that may accompany any incision to gain access to the infraorbital rim and orbital floor is a vertical shortening of the lower lid after healing. This probably occurs as a result of scarring and shortening of the orbital septum. To reduce the incidence of this problem, superior support of the lower lid for several days (or until gross edema has resolved) after surgery is beneficial. The most direct method involves the use of a suture placed through the skin surface of the lower lid just inferior to the gray line that is taped to the forehead (Fig. 2-28). This lifts and supports the lower eyelids in a lengthened position, and helps dissipate lid edema. One may examine the globe and vision simply by removing the tape from the forehead and opening the eyelids. To maintain gentle upward support to the lower eyelid, it is important that the suture be taped to prevent if from slipping. To accomplish this, a three-tape technique has proven effective. The first layer of tape is attached to the skin as a base. The suture is then drawn over the first layer and a second layer of tape applied, with the suture held to the base layer of tape. The suture, however, can still slip between the two layers of tape. To prevent this, the suture is drawn inferiorly over the face of the second layer of tape, and a third layer of tape is then placed over the second.

Sutures With Minimal Scarring
Figure 2-28 Lower eyelid suspensory suture placed at completion of surgery. The suture is placed just below the lower eyelashes (just above the subciliary incision), taking care to engage the tarsal plate. it is taped to the forehead in the manner shown to provide firm suspension.

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