This video is of a bilateral upper eyelid blepharoplasty. For such a basic procedure, I think there are still a lot of questions: What cutting instrument do you prefer? Do you resect the orbicularis muscle? Do you resect medial and/or preaponeurotic fat? And, what is your choice for suturing? I interchangeably use the Colorado needle and the 15 blade. I usually resect orbicularis muscle. I hardly ever take preaponeurotic fat, but I almost always take the medial fat pad. And, I prefer a 6-0 Prolene suture in a running fashion for closure.
For a written transcript of this video, please see below:
This is Richard Allen at the University of Iowa. This video demonstrates an upper eyelid blepharoplasty with medial fat pad excision.
The area has been anesthetized with lidocaine with epinephrine. An incision is then made along the markings with a 15 blade. I usually attempt to make two continues cuts without raising the blade.
One can excise skin only or skin and underlying orbicularis muscle. I this case, I am excising both skin and orbicularis muscle with the monopolar cautery. This could also be performed with scissors.
Hemostasis is attained with bipolar or monopolar cautery with minimal cautery at the skin edges.
Attention is then directed medially where the orbital septum is opened and the medial fat pad is exposed. Sometimes this can be difficult to find. In this case, the fat is exposed relatively easily. The fat is carefully teased forward to prevent deep hemorrhage.
This can sometimes be uncomfortable for the patient. After the fat is exposed, it is anesthetized with lidocaine with epinephrine.
The same procedure is performed on the other side.
The fat is then excised carefully with the monopolar cautery. Some surgeons will clamp the fat at this point. I have found over the years that this has a tendency to place more traction on the fat and potentially cause a deep hemorrhage.
After hemostasis is assured, the incision is closed with 6-0 prolene suture. I will usually start centrally and move laterally with a running suture.
Then a small burrows triangle is excise medially. This is performed with a Westcott scissors. A single 6-0 prolene closes the triangle.
The remainder of the incision is closed with a running 6-0 prolene suture.
Other options for closure include interrupted sutures, a subcuticular suture, as well as the use of other suture materials such as nylon and in some cases fast absorbing suture.
At the conclusion of the case, antibiotic ointment is placed over the incision.
The patient returns in approximately one week for suture removal.
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