Mid-forehead Browplasty

This is Richard Allen at the University of Iowa. This video demonstrates a mid-forehead browplasty. In almost all of these procedures, a concurrent blepharoplasty will be performed. The blepharoplasty markings are incised with a 15 blade. And a flap of skin and orbicularis muscle is removed. This could be a skin-only blepharoplasty if desired. Hemostasis is obtained with the bipolar cautery or a monopolar cautery. These incisions can then be closed with a running monofilament suture of the surgeon’s choice. Attention is then directed to the browplasty. In this situation, two separate incisions will be made rather than one incision across the entire forehead. The markings are usually made in advantageous wrinkles. The incision is made with the 15 blade through the skin and subcutaneous fat. Dissection is then performed between the subcutaneous fat and the underlying frontalis muscle with the monopolar cautery. The amount of lift is then determined and marked with the marking pen. This is then incised with the 15 blade, preferably the marking can also be made in a wrinkle so that two wrinkles are turned into one scar. The excess tissue is then removed with the monopolar cautery. This can be performed both above and below the initial incision. The defect is then closed with deep interrupted 4-0 Vicryl sutures followed by a running 5-0 prolene suture.

The same process is then repeated on the other side where an incision is made with the 15 blade and dissection is carried out between the subcutaneous fat and frontalis muscle. The amount of tissue to be excised for the desired lift is determined and marked. The 15 blade with the aid of scissors is then used to excise the tissue. The reason for the dissection between the subcutaneous fat and the frontalis muscle is to spare transection of the sensory nerves. The defect is then closed with deep interrupted 4-0 [Vicryl] sutures to place minimal tension on the edges of the wound. Superficial sutures are then placed in a running fashion with a 5-0 prolene suture. At the conclusion of the case, antibiotic ointment is placed over the incisions. The patient is seen approximately one week when the sutures are then removed. In general, this is a relatively seldom used procedure due to the danger of creating an unsatisfactory scar. However, for the right patient, it is very effective and can be an acceptable lift.