Raising the upper lid crease
Richard C. Allen, MD, PhD, FACS
Additional Notes: Length 03:57
Posted February 10, 2017
This is Richard Allen at the University of Iowa. This video demonstrates an upper blepharoplasty with internal suture browpexy in a patient with a relatively low lid crease. The goal of the surgery is to increase the patient's tarsal platform show as well as elevate her eyelid crease. An upper blepharoplasty has been marked on each side as well as the area of the browpexy. The blepharoplasty markings are then incised with a 15 blade. A flap of skin and orbicularis muscle is excised with Westcott scissors. This is performed on each side. Due to the patient's relatively low lid crease, the levator/orbital septum will be disinserted from the anterior surface of the tarsus. This will obviate the connections between the levator and the dermis inferiorly. This dissection continues along the anterior surface of the tarsus to the superior border of the tarsus at the insertion of Mullers muscle. This is performed with a thermal cautery which I think is really useful for this dissection. This is performed on the opposite side. Again, the septal/levator aponeurosis confluence is disinserted from the anterior surface of the tarsus inferiorly to negate the lower lid crease. This is performed along the length of the eyelid. This proceeds superiorly until Muller's muscle is exposed. This will be incorporated into the closure of the incision. The internal suture browpexy is then performed. This can be seen in detail in another video. Dissection is carried out superiorly along the surface of the orbital septum to the superior orbital rim. A 4–0 Vicryl suture then engages the periosteum superior to the superior orbital rim. The suture then engages the brow fat at the same distance. The suture is then tied. The eyelid crease incisions are then closed with a 6–0 Prolene suture which engages the cut end of the levator/orbital septum. This is performed with interrupted sutures along the length of the eyelid. This will reestablish the connection of the levator aponeurosis and septum to the dermis but at a higher level. This will raise the patient's eyelid crease and with the browpexy will increase the tarsal platform show. At the conclusion of case, erythromycin ophthalmic ointment is placed over the incisions. The patient will return approximately one week for suture removal.
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