This is Richard Allen at the University of Iowa. This video demonstrates a direct browplasty. The patient also underwent a concurrent upper lid blepharoplasty. The browplasty is marked with a marking pen. A 15 blade is then use to make an incision along the marking. I usually try to make the incision along the inferior and then superior marking in one continuous motion without lifting the  blade so that the incision is continuous. A flap of skin and subcutaneous fat is then excised with the monopolar cautery. It is important to not make this incision too deep so that the dissection does not interfere with [injure] the frontal branch of the facial nerve. Hemostasis can then be obtained with the same unipolar cautery. The defect is then closed with deep interrupted 4-0 Vicryl sutures. The goal of these sutures is to reappose the skin edges with no tension. Usually approximately 5-7 deep sutures are needed. The skin is then closed with a running 5-0 prolene suture. I have tried various skin sutures such as nylon as well as different suturing methods such as running locking and even vertical mattress sutures. I have found a running 5-0 prolene to give a very acceptable and almost imperceptible scar. Prior to tying the suture, the prolene will be tightened as it has some elasticity to it. At the conclusion of the case, antibiotic ointment is placed over the incision and the patient returns in one week for suture removal.