Blepharoplasty/ Brow Lift

Definition

Blepharoplasty: Surgical repair or reconstruction of an Eyelid to remove excess skin, muscle, or tissue from Eyelids.

Brow Lift: Procedure that repositions your forehead to correct wrinkles and sagging eyebrows

Definition

Preoperative Diagnosis

History & Physical Examination

Blepharoplasty: Complete eye exam, Visual field testing, Eyelid photography.

Brow lift: assessment of brow position, gross field eval, presence of existing rythids/ scars, & Preop photos.

Preop Diagnosis

Pt. Positioning

Blepharoplasty: Supine with arms tucked at sides; foam headrest.

Brow Lift: Upright position no facial animation.

Anatomy affected

Blepharoplasty: Lower & Upper eyelid, orbital septum (palpebral ligament), Eye Socket, & slope of nose

Brow lift: occipitofrontalis muscle, & Forehead.

Pt. Positioning

Drugs, Solutions, & Dyes

Both: local anestesia, ointment, prep solution, cellulose sponges

Type of Prep Used

Blepharoplasty: Aseptic surgical preparation for blepharoplasty via full-face scrub

Brow Lift: Aseptic Surgical preparation peramiters determined by type of brow lift.

Drugs, Solu., Dyes

Special Equipment

Both: Headlamp, Marking pen, Bi or Monopolar ESU, Cellulose sponges, Ointment for eyes.

Special equipment

Instrument Set

Blepharoplasty: Plastic instrument set.

Brow Lift: Plastic intrument set

Instrument Set

Sutures

Blepharoplasty: Plain gut suture, and Polypropylene suture.

Brow Lift: Staples or, Coated Vicryl 2-0

Sutures

Specimen

Neither surgery has documented removal of specimen but both have a removal of tissue.

Specimen

Dressings/ Drains

Blepharoplasty: Steri-Strips

Brow lift: Elastic compressive dressings.

Dressing/ Drains

Implants

Although there are no implants used in both Blepharoplasty and Brow lifts there are non surgical implant injection alternatives.

Implants

Possible complications

Blepharoplasty: Temporary vision problems, Eye closure problems, Swelling/ asymmetry changes, acne, Ectropion.

Brow lift: Scarring, Changes in skin sensation, asymmetry in position of the brows, Hair problems

Possible complications

Technique

Surgeon uses a marking pen to indicate the incision lines prior to the injection of the local anesthetic.

Procedural Consideration: If the anesthetic were injected first the anatomy would be distorted.

Using the #15 knife blade an elliptical incision is made along the ciliary margin following the natural curve of the eyelid

Using the jeweler's forceps and Westcott scissors, a skin flap is developed and any redundant tissue, including the medial and central fat pads, is removed.

Procedural Consideration: Great care is used to prevent damage to the levator muscle.

Hemostasis is achieved with the use of cauterization.

Procedural Consideration: The surgical technologist is responsible for gently dabbing the small bleeders in the incision with the use of the Weck-Cel spears, providing the surgeon with a dry visual field, and ability to identify the bleeders to cauterize.

A second incision is made to create a wedge of skin to be excised. 'It is arched above the primary incision and connected at the medial and lateral edges.

Procedural Consideration: A caliper may be used to ensure that the incisions on both eyelids are equal in length and size and to prevent removal of too much tissue, which could cause a permanent inability for the patient to close the eyelids

Technique

Technique pt.2

Direct brow lift involves bilateral elliptical incisions just above the brows. The inferior border of the incision is marked along the superior line of the eyebrow. After digital elevation to the desired height, the pen marks the site of desired elevation. The brow is released, and the forehead is marked at the level of the marker pen to designate the superior border of the ellipse.Dissection is carefully performed superficial to the frontalis muscle, avoiding damage to the supraorbital nerve and vessels.

Technique

Sources

https://pubmed.ncbi.nlm.nih.gov/24173840/

https://princetoneyeandear.com/belpharoplasty/

Https://www.ncbi.nlm.nih.gov/pmc/articals/PMC7151508/

https:/www.plasticsurgery.org/cosmetic-procedures/brow-lift/procedure

5th edition Surgical technology for the surgical technologist a positive care approach Procedures19-3 & 19-4. Pages 736- 739.