Blepharoplasty – Direct Brow Repair

PREOPERATIVE DX: Dermatochalasis, mechanical ptosis, brow ptosis.

POSTOPERATIVE DX: Same

PROCEDURE:: Upper lid blepharoplasty and direct brow lift

ANESTHESIA: Local with sedation

INDICATIONS FOR SURGERY: In the preoperative evaluation the patient was found to have visually significant and symptomatic dermatochalasis and brow ptosis causing mechanical ptosis and visual field obstruction. Visual field testing showed *% superior hemifield loss on the right, and *% superior hemifield loss on the left. These field losses resolved with upper eyelid taping which simulates the expected surgical correction. Photodocumentation also showed the upper eyelids resting on the upper eyelashes, as well as a decrease in the effective superior marginal reflex distance. The risks, benefits, limitations, alternatives, and expected improvement in symptoms and visual field loss were discussed in preoperative evaluation.

DESCRIPTION OF PROCEDURE: On the day of surgery, the surgical site and procedure were verified by the physician with the patient. An informed consent was signed and witnessed. EMLA cream was applied to the eyelids and eyebrow region for 10 minutes to provide skin anesthesia. Two drops of topical proparacaine eye drops were placed on the ocular surface. The skin was cleaned with alcohol prep pads. The patient received 3 to 4 mL of 2% Lidocaine with epinephrine and 0.5% Marcaine mixture to each upper lid. 5 to 6 mL of local were also given to the brow region along the entire length. Pressure was applied over each site for 5 minutes. The patient was then prepped and draped in the normal sterile fashion for oculoplastic surgery.

The desired amount of redundant brow tissue to be excised was carefully marked with a surgical marking pen on each side. The contour of the outline was created to provide a greater temporal lift. Care was taken to preserve a natural contour to the brow shape consistent with the patient