Internal Suture Browpexy
This video demonstrates a quantitated internal suture browpexy. The patient will have a concurrent upper blepharoplasty. The blepharoplasty marking is incised with the monopolar cautery. A flap of skin and orbicularis is excised. This could be a skin only blepharoplasty, if desired. Medially, the orbital septum is opened and the medial fat pad is identified and mobilized. This fat pad is then conservatively excised. Dissection is then carried out superiorly between the orbital septum and the orbicularis muscle. Dissection continue on the surface of the orbital septum beneath the brow fat to the superior orbital rim. The superior orbital rim is identified and dissection is carried out superior to the superior orbital rim in a preperiosteal plane. A Desmarres retractor is placed and a freer periosteal elevator is used to dissect along the surface of the periosteum. Calipers are then used to measure approximately 12 to 15 mm superior to the superior orbital rim at the level of the peak of the brow. A 4-0 vicryl suture on a P-2 needle is then placed through the periosteum at this marking. Calipers are again used to measure superior to the superior incision the same distance as before, and the 4-0 is placed. Tying this suture effectively places the superior incision at the superior orbital rim. The brow appears to be in good position. Attention is then directed to the opposite side where the same dissection is carried out along the surface of the orbital septum to the superior orbital rim. The superior orbital rim is identified and a preperiosteal dissection is performed with the freer periosteal elevator superior to the superior orbital rim. The calipers are at the same measurement as the other side, 12-15 mm. The 4-0 vicryl suture is placed at the level of the peak of the brow. The measurement is from the superior orbital rim. The calipers are then used to measure from the superior incision the same amount. The 4-0 vicryl suture is then placed through what is usually the brow fat. Tying this suture effectively places the superior incision at the level of the superior orbital rim. The blepharoplasty incisions can then be closed with the suture of the surgeon's choice. In this case, a 6-0 prolene suture is used; this is placed in a running fashion. At the conclusion of the case, antibiotic ointment is placed over the incisions. The patient returns in approximately one week for removal of the prolene sutures.