A Modified Technique for Brow Suspension: Use of 3-0 Prolene

Abstract Introduction: Congenital ptosis can occur in isolation or part of both ocular and systemic associations. Complications vary and less reported is extrusion of the suspensory material and granulomatous reaction. We present a surgical technique used in five cases, all who had extrusion of their synthetic brow suspension material and had subsequent successful surgery with this modified technique. Methods – Surgical Technique: All surgeries were performed by one Consultant Oculoplastic Surgeon at the Birmingham Midland Eye Centre, United Kingdom. The main modification is the use of Prolene as the suspension material as well as extra 6-0 Vicryl sutures to anchor the suspension more securely. Results: This technique was used in five patients, and a retrospective analysis of their case notes was performed. None of the patients needed further revision surgery, and there were no reported complications, including extrusion or granuloma formation. Discussion: Prolene proved beneficial in these cases, as it is strong, does not degrade over a number of years, and can be considered permanent, with lower rates of infection. Our technique is similar to the approaches already described in the open-sky approach; however, we use Prolene due to its advantageous properties described, as well as the extra Vicryl sutures to anchor the suspension more securely. Conclusion: We report a modified technique for brow suspension to prevent extrusion in challenging cases, where extrusion has already been a problem with the initial surgery. This technique could also be used as a primary technique when a synthetic material is being considered.