Revision of silicone frontalis sling
This is Richard Allen at the University of Iowa. This video demonstrates revision of a previously placed silicone sling for recurrent ptosis.
The previous central incision above the brow is marked with a marking pen.
The mark is then incised with a 15 blade. The incision is just through the dermis. It is very important not to cut the sling during this maneuver as you would then need to replace the entire sling. The incision is really just made through the skin and maybe just a little bit of the subcutaneous fat.
Then careful blunt and sharp dissection are performed with scissors until the frontalis sling is visualized. Usually you will be able to visualize the sleeves which can then be pulled through the incision with non-toothed forceps or an empty needle holder. This will usually slip out but can sometimes be caught on the previous placed Mersilene sutures.
The previous placed Mersilene is removde from the superior half of the sleeve, the lower Mersilene is left intact because the sleeve can slide over it.
The patient is then placed in a sitting position and the height and contour are inspected. Once an appropriate height and contour are obtained, the top sleeve is slipped down and the Mersilene suture can then be removed risk free.
As when the Mersilene suture were first placed, they are replaced in a similar fashion.
One suture is placed around the sling inferior to the inferior sleeve and an additional suture is placed around the superior half of the sleeve.
The redundant portion of the sling is then excised and the sling is reposited into the pocket above the brow incision. The incision is then closed again with a single layer of 5-0 fast absorbing suture in a vertical mattress fashion.
I do not place any deep Vicryl sutures as I believe a suture granuloma may result in sling exposure.