Double fixation for repair of brow ptosis
Richard C. Allen, MD, PhD, FACS
Additional Notes: Length 02:48
This is Richard Allen at the University of Iowa. This video demonstrates the use of both the Endotine forehead device as well as the transblepharoplasty Endotine in the treatment of a younger male with brow ptosis. A 15 blade is used to make an incision along the relatively conservative blepharoplasty incisions. Dissection is then carried out superiorly between the orbital septum and orbicularis muscle to the superior orbital rim. The superior orbital rims are identified and the periosteum is incised. The periosteum is then elevated from the underlying bone superiorly. Incisions are then made in the scalp, and the standard endoscopic brow lift is performed in order to perform a subperiosteal dissection extending to the conjoined tendon. Dissection is then carried out along the surface of the deep temporalis fascia and the conjoined tendon is lysed on either side. This results in the forehead being completely mobile. The patient is a younger male and has relatively heavy brows. It was thought that an Endotine forehead device alone would not be sufficient. The Endotine forehead device is placed on both sides which results in brow elevation as noted. The temporal incisions are closed deep to plicate the superficial temporalis fascia. Attention is then directed to the browpexy portion of the procedure. The manual Endotine drill is used to make a hole in the bone. The transblepharoplasty device is placed in the bone. A 5-0 nylon suture is used to hold the brow into position postoperatively. This is shown in more detail in the transblepharoplasty Endotine browpexy video. The same procedure is performed on the other side with drilling of the hole followed by placement of the transblepharoplasty Endotine device. The nylon sutures are then used to hold the brow into position in the early postoperative period. These nylon sutures are taken out at a week. Staples are used to close the scalp incisions. The eyelid incisions are then closed with interrupted and running 6–0 Prolene sutures. At the conclusion of the case, the patient is cleaned with wet and dry gauze. Erythromycin ophthalmic ointment is placed over the eyelid incisions. A headband is placed for 2 days and patient follows up in approximately 1 week for suture removal.
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