In the article titled "Adjustable Suture Technique for Levator Recession" by Woog et al,1 the authors conclude that adjustable sutures may be a useful adjunct in levator recession surgery based on their experience with 10 patients, 1 of whom required a postoperative suture adjustment.
In 1982 I dubbed adjustable sutures in levator aponeurosis recessions "trombone sutures"2 because of the ease with which I thought I could move the eyelid up and down with adjustable sutures after surgery. My initial enthusiasm has lessened. In 1995 I reviewed 181 eyelid recessions.3 Twenty-two percent (32%) of 68 eyelids recessed with adjustable sutures in the levator aponeurosis required reoperation compared with 4 (12%) of 33 eyelids recessed without adjustable sutures. In 62 eyelids recessed by the pre-Whitnall technique, all had adjustable sutures and 13 (21%) required reoperation. In the pre-Whitnall technique the muscle is recessed high in the orbit above the
Small RG. Adjustable Suture Technique for Levator Recession. Arch Ophthalmol. 1997;115(2):295. doi:10.1001/archopht.1997.01100150297038