This is Richard Allen at the University of Iowa. This video demonstrates an upper eyelid blepharoplasty. The upper eyelid crease and a conservative blepharoplasty have been marked with a marking pen. A 15 blade is then used to make an incision along these markings. The incision could also be made with a monopolar cautery or a CO2 laser depending on the surgeon’s choice. Westcott scissors are then used to excise a flap of skin and orbicularis muscle in this case. A skin-only blepharoplasty could also be performed if the patient has dry eye or instances in which more fullness is desired in the upper lid. The orbital septum is then opened medially and the medial fat pad is prolapsed forward. Manipulation of the fat pad can be uncomfortable, so it should be injected with local anesthesia. The same procedure is then performed on the other side. Hemostasis can be obtained with the bipolar or monopolar cautery. The fat pad can then be excised. On this side it is excised with Westcott scissors. The disadvantage of doing this is potentially having some issues with superficial or deep bleeding. On the other side the fat pad is removed with the monopolar cautery. The incisions can then be closed. In this case a running 6-0 prolene suture is used. I usually start in the middle and move laterally. The suture could also be a nylon or fast absorbing gut, depending on the surgeon’s preference. Medially a burrow’s triangle will be excised. This is performed in order to pevent redundant skin post-operatively in this area. The triangle is then collapsed with a single suture. The remaining portion of the incision is then closed with the same 6-0 prolene suture. The closure is similarly performed on the other side. The patient will return in one week for suture removal. Post-operatively the patient will use erythromycin ointment or any other antibiotic ointment over the incisions.
