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Repair of Mechanical Ptosis via Blepharoplasty Using CO2 Laser Operative Sample

PREOPERATIVE DIAGNOSIS:  Mechanical ptosis, both upper lids.

POSTOPERATIVE DIAGNOSIS:  Mechanical ptosis, both upper lids.

OPERATION PERFORMED:  Repair of mechanical ptosis, both upper lids via an upper lid blepharoplasty using the CO2 laser.


ANESTHESIA:  A 50/50 mix of 2% Xylocaine with 1:100,000 epinephrine and 0.75% Marcaine with 1:100,000 epinephrine.  A total of 1 to 2 mL infiltrated in each upper lid and an additional 1 mL underneath the lateral brow on each side.

OPERATION IN DETAIL:  The patient was met in the holding area where the upper lid creases were marked.  Then, using a pinch technique, a moderate amount of excess skin was delineated in both upper lids.  Also noted to have fairly significant lateral brow ptosis and thus I also planned to do an internal browpexy to at least suspend his brow and keep it from falling down on his eye lids further.  IV sedation was administered and the above-mentioned anesthetics were injected.  He was taken to the major OR where tetracaine was placed in both eyes.  He was prepped and draped in the usual manner for sterile facial surgery.  Metal shields were placed in both eyes.  A CO2 laser to superpulse setting of  5 watts was then used to incise the skin, first to the right upper lid and then the left upper lid, along the previous markings.  Burow triangles were excised nasally, and then the laser was used to dissect through the subbrow fat pad over the lateral half of the brow, care being taken to stay lateral to the supraorbital nerve, creating a pocket superiorly, centered over the lateral canthal angle.  This was done first on the right side, then the left side, 5-0 silk sutures were then used to grasp the subbrow tissue along the inferior edge of the brow, and it was attached to the periosteum approximately 3 to 4 mm higher.  These were bow-tied and he was asked to open his eyes and tilt his head forward and good contour of the upper lids were obtained.  These were then tied permanently, and the wounds were then closed with running and interrupted 5-0 plain collagen.  Metal shields were removed.  Polysporin ointment was placed in both eyes and along the wounds.  He tolerated the procedure well without complications.  Estimated blood loss was less than 1 to 2 mL.  There were no complications.