Rectus muscle plication surgery. a. A single-armed 6-0 polyglactin acid suture is passed and secured on the muscle at the selected amount of plication. b. A second single-armed 6-0 polyglactin acid suture is passed and secured on the muscle at the selected amount of plication. c. The sutures are then fixated, using partial scleral thickness passes, next to the corresponding corner of the insertion of the rectus muscle. A muscle hook is used to fold the muscle anteriorly while the sutures are tightened, and the muscle is folded flat such that the folded aspect of the muscle is anteriorly placed. d. The suture ends are tied in a slip- knot fashion to place the plication on an adjustable suture.