Transblepharoplasty Endotine Browplasty
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This is Richard Allen at the University of Iowa. This video demonstrates a browpexy using a trans-blepharoplasty Endotine device. This is a subperiosteal browpexy. A blepharoplasty has been marked on both sides and the monopolar cautery is used to incise the markings and excise a flap of skin and orbicularis muscle. This is usually a bilateral procedure. The medial fat pad is exposed, mobilized, and excised on both sides. The brow is inspected and the area of the proposed lift is marked. This is a relatively weak browlift and is likely more of a brow stabilization. Dissection is then carried out on the anterior surface of the orbital septum to the superior orbital rim. The periosteum of the superior orbital rim is incised with the needle point cautery. A Freer periosteal elevator is then used to dissect the periosteum from the underlying bone. An identical dissection is performed on the other side between the orbital septum and orbicularis muscle to the superior orbital rim. Attention is redirected to the right side where additional subperiosteal dissection is carried out superiorly to mobilize the tissue above the brow. The Endotine drill is then used to make a hole into the superior orbital rim at the level of the proposed pexy. The preloaded transblepharoplasty Endotine is then placed into the hole. A double armed 5-0 nylon suture has been placed through the holes of the Endotine device. The periosteum is then elevated above the prongs of the Endotine and the nylon suture is placed transcutaneously to exit out the superior brow cilia to hold the tissue into position. The suture is tied. The same procedure is performed on the opposite side with the hole drilled with the Endotine drill, followed by placement of the device into the hole and elevation of the periosteum over the prongs of the device. The blepharoplasty incisions are closed with the suture and method of the surgeon's choice. The patient will return in one week for removal of the nylon sutures as well as the blepharoplasty sutures. Antibiotic ointment is placed over the incisions three times per day for one week. The brows appear to be in good position, but again this is more of a brow stabilization procedure rather than a significant browlift.