Pre-periosteal cheek lift with Vicryl suture
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This is Richard Allen at the University of Iowa.
This video demonstrates a pre-periosteal cheek lift with a Vicryl suture.
The patient has a history of cicatricial ectropion secondary to actinic damage. A lateral canthotomy is performed with the needle tip cautery. This is followed by an inferior cantholysis. A 4-0 silk suture is placed for traction. A transconjunctival incision is made inferior to the inferior border of the tarsus with the needle tip cautery. Dissection is then carried out between the orbicularis muscle and the orbital septum to the inferior orbital rim. The inferior orbital rim is identified and a shoe horn speculum is placed. The needle tip cautery is used to expose the periosteum of the inferior orbital rim. The freer periosteal elevator is then used to dissect along the surface of the periosteum in a pre-periosteal plane. A 4-0 Vicryl suture on a half circle needle is used to engage the soft tissue of the cheek in the area of the SOOF (suborbicularis oculi fat). This suture then engages the periosteum of the inferior orbital rim. The suture is then tied. An additional suture is placed laterally, again through the soft tissue of the cheek followed by the periosteum of the inferior/lateral orbital rim. The suture is tied.
The eyelid is then inspected and the conjunctiva is re-apposed to the inferior border of the tarsus with a 7-0 Vicryl suture in an interrupted fashion. The silk suture is removed and the lateral tarsal strip is fashioned by dissecting between the anterior and posterior lamella for approximately 1 cm. The mucocutaneous junction of the posterior lamella is excised. The posterior surface of the strip is scraped with a 15 blade. The strip is then shortened the appropriate amount with Westcott scissors. The strip is engaged with a double armed 4-0 Mersilene suture placed posterior to anterior. The second arm is placed. The suture then engages the periosteum of the lateral orbital rim at the level of Whitnall's tubercle. The other arm of the suture is placed in the exact same manner, again engaging the periosteum. The suture is left untied. The lateral portion of the mucocutaneous junction of the upper lid is excised. A 5-0 Vicryl suture is then used to engage the lateral portion of the upper eyelid followed by the lateral tarsal strip. The suture is then tied. The lateral tarsal strip sutures are then tied, tightening both the upper and lower lid. The lashes of the lower anterior lamella are excised. The canthotomy incision is then closed with 7-0 Vicryl sutures. At the conclusion of the case, the eyelid appears to be in good position. Antibiotic ointment is used three times per day and the patient is reevaluated in one week.