What do you do if you’re a surgeon and want to explain an innovative technique for suturing a corneal or limbal incision? Well, that’s a common question with an easy answer: you hire an illustrator, such as myself, to help you do that. Then, when you publish, it looks real good and other surgeons can do the cool knot too.

The challenge that Dr. Julio Narvaez was facing, is that his processes couldn’t be duplicated. He had already published his article once, with simple line drawings that showed the knotting technique, but something wasn’t being communicated. So he hired me. He provided me with movie files showing actual footage of the suturing and articles with photos and illustrations. Armed with these tools, I went through a series of sketches and then final illustrations. As I went the knotting procedure myself – with shoelaces – I could see how the string needed to twist and be manipulated in order to make the knot work. The first part of the knot results in a slip-knot of sorts, which the surgeon tightens to the desired level. The second knot needs to be pulled taut in a specific way in order to “lock” the sliding knot – but can easily become another sliding knot if not handled correctly. So, I illustrated this with attention to the position of the tools being used, especially in the final two figures (9-10).