Chapter 5.33: The Frost Suture

Temporary eyelid suspension suture

This is a niche approach, used to secure the lower eyelid margin in place to help prevent postoperative ectropion. It is useful when there is concern that postoperative edema could result in a downward pull on the lower eyelid during the postoperative period. It is not, however, to be used to correct ectropion that is apparent intraoperatively.

Usually, a 4-0 nonabsorbable monofilament suture is adequate for Frost suture placement.

1. After the closure has been completed, the needle is inserted through the tarsus or just inferior to it.

2. With a fluid motion of the wrist, the needle is rotated, taking a 3-mm bite.

3. The needle is then reloaded and passed through the skin above the medial eyebrow, keeping the angle and placement of the lower lid in its anatomic position.

4. The suture material is then tied off gently, forming a sling. Alternatively, the positioning above the medial eyebrow may be secured using adhesive strips (Figures 5-33A, 5-33B, 5-33C, 5-33D).

Knowledge of eyelid anatomy is critical before embarking on this oculoplastic technique. The suture should penetrate the tarsus or directly inferior to it, but care should be taken to avoid the inferior lateral punctum or canaliculus.

This technique is designed to prevent the eyelid from developing an ectropion in the postoperative period. It is not, however, able to correct an ectropion that is already apparent intraoperatively. Sutures may be removed approximately 3 days postoperatively, but may be left in place longer if a large amount of postoperative edema or bleeding is present.

The superior anchor point may be secured with adhesive strips and liquid adhesive if desired, which also permits adjustment of the tension across the suture in the postoperative period based on the degree of edema.

As noted previously, suture placement in the medial lower eyelid should only be undertaken by those with a thorough familiarity and comfort with eyelid anatomy.

Since the sling of suture projects in front of the eye, patients should be educated regarding postoperative care and may consider using an eye patch in order to protect the area from inadvertent tugging on the suture.