To investigate the morphologic changes in Supramid Extra suture harvested from patients displaying recurrent ptosis who had undergone a frontalis suspension f or congenital ptosis. Observational case series. Using scanning electron microsc opy, we examined the morphologic changes in Supramid Extra (S. Jackson Inc, Alex andria, Virginia, USA) harvested from 20 consecutive patients (23 eyelids) with recurrent ptosis who had undergone frontalis suspension. Disintegration was grad ed as mild, moderate, or severe. Examination of unused Supramid showed the smoot h surface of the sheath and round, well de marcated polyfilaments on cross sec tion. However, implanted Supramid showed different degrees of disintegration. Th e surface of the sheath had a rough texture with cracks and peeling. On cross se ction, an accumulation of debris among the polyfilaments and irregular architect ures with decreased diameters of the polyfilaments were noted in some cases. On the surface of polyfilaments, different degrees of debris were noted in all case s. The degree of the changes was not exactly correlated with either the time of the recurrence or the duration of implantation. However, as the duration of impl anted Supramid increased, greater changes on the surface of the sheath were note d. With implantation of less than 37 months, mild changes (44%) were predominan t; between 37 and 48 months, moderate changes (60%) were noted, and with more t han 48 months of implantation, severe changes (44%) were predominant. Supramid undergoes morphologic degradation by hydrolysis after implantation. This change might be considered one of the possible factors that facilitate the recurrence o f ptosis. To investigate the morphologic changes in Supramid Extra suture acquired from patients displaying recurrent ptosis who had undergone a frontalis suspension f or congenital ptosis. Observational case series. Using scanning electron microsc opy, we examined the morphologic changes in Supramid Extra (S. Jackson Inc, Alex andria, Virginia, USA) harvested from 20 consecutive patients (23 eyelids) with recurrent ptosis who had undergone frontalis suspension. Disintegration was grad ed as mild, moderate, or severe. Examination of unused Supramid showed the smoot h surface of the sheath and Round, well de marcated polyfilaments on cross sec tion. However, implanted Supramid showed different degrees of disintegration. Th e surface of the sheath had a rough texture with cracks and peeling. On cross se ction, an accumulation of debris among the polyfilaments and irregular architect ures with decreased diameters of the polyfilaments were noted in some cases. On the surface of polyfilaments, diffe rent degrees of debris were noted in all cases s. The degree of the changes was not exactly correlated with either the time of the recurrence or the duration of implantation. However, as the duration of impl anted Supramid increased, greater changes on the surface of The lesions were less than 37 months, mild changes (44%) were predominan t; between 37 and 48 months, moderate changes (60%) were noted, and with more t han 48 months of implantation, severe Changes (44%) were predominant. Supramid undergoes morphologic degradation by hydrolysis after implantation. This change might be considered one of the possible factors that facilitate the recurrence of ptosis.