Abstract Purpose: This study aimed to report the outcomes of correcting severe congenital blepharoptosis by frontalis suspension using combined silicone tube and 2-0 green braided polyester suture (Ethibond), and to compare the results with those of silicone rod alone and Ethibond suture alone. Patients and methods: The medical records of patients below 16 years who underwent frontalis suspension were retrospectively reviewed. Three groups of patients were identified; group I (16 patients: 22 eyelids) had frontalis suspension surgery using silicone suspension set, group II (18 patients: 25 eyelids) underwent the surgery using Ethibond suture, and group III (15 patients: 23 eyelids) was operated on using combined silicone and Ethibond suture. The primary outcome measures were postoperative marginal reflex distance-1 (MRD-1) and postoperative symmetry, and the secondary outcome measures were the occurrence of complications; mainly recurrence and wound-related complications. The follow-up data were collected after 1 week, 1 month, 6 months, 12 months and every 6 months thereafter. Results: The follow-up period ranged from 18 to 36 months. By the last follow-up visit, 13 eyelids in silicone group (59%), 11 eyelids in the Ethibond group (44%), and 13 eyelids in the double sling group (57%) achieved good surgical correction with MRD1 ≥3mm; these differences were not statistically significant. The difference in symmetry among the three groups was not significant. The highest rates of recurrence (44%) and wound-related problems (8%) were encountered in the Ethibond group, while the silicone group had no cases of wound-related problems. The lowest recurrence rate (26.1%) was in the double sling group but those differences were not significant. Conclusion: Combined use of silicone and Ethibond suture in frontalis suspension surgery could offer lower recurrence rate and good final surgical outcome when compared to silicone rod or Ethibond suture alone. Keywords: Ethibond; double sling; frontalis suspension; ptosis; silicone tube. © 2022 Mattout et al.