Direct Browplasty for Paralytic Brow Ptosis

This is Richard Allen at the University of Iowa.  This video demonstrates repair of a right paralytic brow ptosis secondary to a 7^th nerve palsy.  The amount of elevation needed is determined pre-operatively and marked with a marking pen.  A 15 blade is then used to make an incision along the marking.  The depth of the incision should be through the skin and subcutaneous fat.  A monopolar cautery is then used to remove a flap of skin and subcutaneous fat. As this is a paralytic brow ptosis, a deeper dissection can be performed if preferred.  The defect is then closed with deep interrupted 4-0 vicryl sutures.  In this case, a medial cut back is performed to address additional medial brow ptosis, and a Burrows triangle is removed.  Additional 4-0 Vicryl sutures are placed in order to close the deep layer.  A 5-0 prolene suture is then used to close the skin.  Medially in the area of the cut back, a two vertical mattress sutures are used.  A running prolene suture can be used to close the remainder of the incision.  The patient will return in approximately one week for removal of the prolene sutures.  Prior to tying the running suture, the prolene will be tightened which I believe is important as prolene has some elasticity to it.  At the end of the case, the brow appears to be in appropriate position.  Antibiotic ointment is then placed over the incision.