This video demonstrates a direct browplasty procedure. In addition the patient will also have an upper blepharoplasty.
The blepharoplasty incisions are incised with the 15 blade. A flap of skin only is excised in this case with Westcott scissors.
Hemostasis is obtained with the monopolar cautery.
Attention is then directed to the browplasty markings.
The incision along the upper border of the brow is incised with the 15 blade. The upper marking is then incised with the same blade.
A flap of skin and subcutaneous fat is excised with the monopolar cautery.
This dissection should not extend deeper than the subcutaneous fat. Hemostasis is obtained with the monopolar cautery.
The browplasty incision is then closed with deep interrupted 4-0 Vicryl suture placed in a buried fashion.
The goal of this closure is to take tension off of the skin edge.
Usually approximately 6-8 sutures will need to be placed to attain a reasonable deep closure.
The skin can then be closed with a number of different types of sutures and techniques. In this case, a running 5-0 prolene suture is used.
Some surgeons like to place locking sutures, some like to place subcuticular sutures. I have found a running 5-0 prolene suture to work pretty well.
Again, the goal here is to give as good of a closure as possible due to the fact that this brow elevation technique can give an unfavorable scar.
After the prolene is place and prior to tying it, the sutures are tightened in order to attain an eversion to the wound edge.
These sutures will be removed at one week. The blepharoplasty incision is then closed with a 6-0 prolene suture.