Upper eyelid blepharoplasty with monopolar cautery
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This is Richard Allen at the University of Iowa. This video demonstrates an upper eyelid blepharoplasty using the monopolar cautery.
An incision is made along the blepharoplasty and upper eyelid crease marking. This is made through the skin and orbicularis muscle.
An upper blepharoplasty can be skin only or also include the underlying orbicularis muscle depending on the patient. In this case the underlying orbicularis muscle is excised and the orbital septum is exposed.
The advantage of the monopolar cautery is quick hemostasis. A potential disadvantage is unfavorable scar along the incision compared to a blade.
Lateral orbicularis is completely excised in an attempt to lessen postoperative brow descent.
The orbital septum is then opened medially with the monopolar cautery to expose the medial fat pad. The medial fat pad can sometimes be difficult to find.
The medial fat pad is more white compared to the more yellow preaponeurotic fat. The fat pad is teased forward and then anesthetized with lidocaine with epinephrine.
It is then excised with the monopolar cautery. Hemostasis is assured with the monopolar cautery and any additional fat can be sculpted with the cautery.
The upper eyelid incision is then closed with a running prolene suture. I start centrally and then move laterally.
Other suture options include interrupted sutures, subcuticular sutures, and the use of other suture materials such as nylon or fast absorbing gut.
A small burrows triangle is then excised medially to prevent redundant skin in this area postoperatively. This is performed with the Westcott scissors.
A single prolene suture is used to collapse the triangle.
The remainder of the incision is closed with a running 6-0 prolene suture.
The procedure is performed on the other side. Antibiotic ointment is placed over the incisions. The patient returns in approximately one week for suture removal.
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