Small incision browplasty with transection of the corrugators
Richard C. Allen, MD, PhD
Additional Notes: Length 04:17
This is Richard Allen at the University of Iowa. This video demonstrates an endoscopic browplasty with upper lid blepharoplasty as well as transection of the corrugators in a male patient. The needle point cautery is used to make an incision along the upper blepharoplasty markings. A flap of skin and orbicularis muscle is then removed. Hemostasis is obtained with the unipolar cautery. The same procedures performed on the opposite side. Dissection is then carried out superiorly between the orbicularis muscle and the orbital septum. The orbital septum is then followed to the superior orbital rim. The periosteum of the superior orbital rim is identified and incised with the needle tip cautery. Medially, careful dissection is performed in order not to damage the supraorbital nerve. A Freer periosteal elevator is then used to elevate the periosteum from the underlying bone. In males, periosteum is usually quite adherent to the bone. The supraorbital neurovascular bundle is identified and dissection is carried out medially along the bone. The needle tip cautery is then used to transect the corrugators. This muscle runs just deep to the dermis. Additional dissection is carried out medially where additional fibers of the corrugators are identified and transected with the needle point cautery. One should be careful in this area because the supratrochlear neurovascular bundle does run in this area. In addition, the corrugator muscle is vascular and will bleed. A combination of unipolar as well as bipolar cautery should be used. Inspection of the area shows the corrugators to be transected. This is demonstrated with release of the glabella.
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 Freer periosteal elevator is then used to dissect the periosteum from the bone superiorly. Medially, dissection is carried out medial to the supraorbital neurovascular bundle. The corrugators are then again identified and transected. Portions of the corrugators can also be excised. Again hemostasis is obtained with unipolar cautery. One should stay medial to the supraorbital neurovascular bundle. The endoscopic browplasty is then performed as noted in previous videos. Dissection is carried out along the surface of the deep temporalis fascia. The conjoint tendon is then transected and the forehead is completely mobile. Additional dissection is carried out from above with long gold handled elevators along the root of the nose. The brows are elevated in this case with the Endotine forehead devices. The blepharoplasty incisions are then closed.
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