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—We thank Dr Silver for his comments, and he is correct in suggesting that it is safer to pass the needle from inferior to superior while placing an eyelid plate between the lid and globe. However, while these maneuvers may be safer for some surgeons, we have noted the following difficulties in obtaining the desired effect when using these procedures:
We place fascia in a base-down triangle fashion in the eyelids. Maneuvering the needle superiorly would involve its passage with fascia in the eyelet. This is a very difficult and traumatic pass that sometimes results in a tear in the fascia.
It is virtually impossible to make the near right-angle turn necessary to change the direction of a needle that is behind the orbital septum at the arcus marginalis to a position anterior to the supraorbital rim and behind the frontalis muscle when passing from inferior
Anderson RL, Patrinely JR. Variation in Technique for Frontalis Suspension-Reply. Arch Ophthalmol. 1987;105(4):456-457. doi:10.1001/archopht.1987.01060040026010