Figure 2.

Steps in frontalis suspension operation. A: Typical incisions in the upper eyelid and above the eyebrow. B: Subcutaneous insertion of polytetrafluoroethylene (Gore-Tex®) sutures from the edge of the upper eyelid to the caudal portion of the frontalis muscle. C: The two sutures are positioned to form the lateral and medial two loops (squares) of rectangular shape. D: Sutures brought out laterally and medially before tying the knots. E: Final status with desired slight opening of the eyelid after tying and burying the knots and stitching the skin incisions. The final step is to apply eye ointment and a special dressing that allows both eyes to be opened immediately after surgery. F: The subcutaneous position of the polytetrafluoroethylene sutures is illustrated in an idealized manner. The arrows indicate the direction of force of the frontalis muscle. By suspending the upper eyelid from the caudal frontalis muscle, the upper eyelid can be actively raised by the patient.