Small incision browplasty with elevation of the medial brow
Richard C. Allen, MD, PhD, FACS
Additional Notes: Length 02:59
This video demonstrates an endoscopic brow plasty with attention to the medial portion of the brows. The patient has significant medial brow ptosis. A conservative blepharoplasty has been marked on each side. The markings are then incised with the needle tip cautery. The needle tip cautery is then use to excise a flap of skin and orbicularis muscle. Dissection is then carried out superiorly between the orbital septum and the orbicularis muscle to the superior orbital rim. The periosteum of the superior orbital rim is then elevated from the underlying bone. Incisions are then made in the scalp and the long-handle periosteal elevator is used to elevate periosteum between the conjoined tendons to the nasal bone. Additional dissection is carried out with the Freer periosteal elevator from the blepharoplasty incisions. A 15 blade is then used to make an incision along the medial brow markings. A 3–0 Vicryl suture is placed through the blepharoplasty incision to exit out the stab incision. The suture is then turned back around and retrieved from the blepharoplasty incision. This engages the brow medially. The same is performed on the other side with the suture being placed from the blepharoplasty incision, out the stab incision, and then back through and retrieved from the blepharoplasty incision. Sinoscopy forceps are then placed through the scalp incisions to retrieve the Vicryl sutures on either side. Tension on the sutures results in elevation of the medial brows. The sutures are tied to the galea superiorly at the edges of the scalp incisions. This results in elevation of the medial brows. Temporally, the browplasty is performed as shown in the previous endoscopic browplasty videos. The scalp incisions are then closed with staples. The blepharoplasty incisions are then closed with 6–0 Prolene suture in a running fashion. The stab incisions can then be closed with a 6-0 Prolene suture in an interrupted fashion. At the conclusion of case, erythromycin ophthalmic ointment is placed over the incisions. The patient is cleaned with wet and dry guaze. The patient returns 1 week for suture and staple removal and reevaluation.