Browplasty using prominent forehead wrinkles
Richard C. Allen, MD, PhD, FACS
Additional Notes: Length 03:35
This is Richard Allen at the University of Iowa. This video demonstrates a browplasty using prominent wrinkles in the patient's forehead. The patient previously had the upper eyelid skin excised for the blepharoplasty. The 15 blade is then used to make an incision along the markings on the forehead wrinkles. Again, this is best for a male who has relatively prominent forehead head wrinkles and temporal brow ptosis. The same incision is performed on the opposite side. The Colorado needle is then used to excise a flap of skin and subcutaneous fat. You need to be relatively careful with regards the depth of your incision. Lateral to the conjoined tendon, the incision should not extend deeper than the subcutaneous fat to avoid damage to the facial nerve. Medial to the conjoined tendon, the incision should extend to the surface of the frontalis muscle. Hemostasis is obtained with the unipolar cautery. The incisions are then closed with deep interrupted 4–0 Vicryl suture. The same procedure is performed on the opposite side. The 4–0 Vicryl sutures are placed in order to have minimal tension on the skin closure. The skin can then be closed with a running 5–0 Prolene suture. I do not believe that you need to place mattress sutures for this closure. Due to the fact that the incision is in a forehead wrinkle, this will usually heal relatively well. However, I would never perform this as a cosmetic procedure due to the risk of unfavorable scarring. The sutures should be tightened. Prolene has the advantage of being elastic as opposed to nylon which is a relatively stiff suture. The blepharoplasty incisions can then be closed with a 6-0 Prolene suture. At the conclusion of the case, erythromycin ophthalmic ointment should be placed over the incisions. The patient will return in approximately 1 week for removal of the sutures. The patient should be instructed to avoid significant sunlight exposure to the incisions for the first 6 months after the surgery. I would also recommend that the patient use Vitamin E oil over the incisions on the forehead for the first months after the surgery and also massage the scars.
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January 9, 2017