Skin only upper blepharoplasty
Richard C. Allen, MD, PhD, FACS
Additional Notes: Length 03:32
Posted Feb 10, 2017
This is Richard Allen at the University of Iowa. This video demonstrates a skin only blepharoplasty. A blepharoplasty has been marked on each side. The 15 blade is then used to make an incision along the markings. This patient has a history of dry eye and therefore we wanted to preserve orbicularis function. Westcott scissors are then used to excise a flap of skin. Dissection is carried out between the dermis and the underlying orbicularis muscle. There are many philosophies out there with regards to when to take and when not to take orbicularis muscle. Many people like to retain some fullness to the upper lid as the redundant skin is excised. Therefore, they will keep the muscle. most of us like to maintain muscle in patients with any dry eye. There is a bit more bleeding just due to the fact that the muscle is vascular. The same procedure is performed on the other side with dissection between the orbicularis muscle and the dermis. Again, hemostasis will be obtained with the unipolar cautery. The medial fat pad is identified and mobilized on each side. The fat pad will then be infiltrated with 1% lidocaine with 0.375% bupivacaine with epinephrine. The fat pad is then conservatively excised. This patient did have a browpexy performed at the same time which is demonstrated in another video. I think it is advantageous to perform a browpexy in these patients due to the fact that the orbicularis muscle is a brow depressor. Performing the browpexy may maintain the height of the eyebrows. At the conclusion of the case, the brows appear to be in good position. The incisions can then be closed with interrupted and running 6–0 Prolene sutures. A Burrow's triangle is excised medially. This is performed almost in all of my blepharoplasty patients who have a fair amount of skin removed. The patient will use erythromycin ophthalmic ointment 3 times a day over the incisions. She will follow up in approximately 1 week for reevaluation and suture removal.
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