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A. G. Amacher, III, R. A. Mazzoli, W. R. Raymond, IV; Observations of Subperiosteal Injection for Endoscopic Browpexy Surgery. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3144.
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Endoscopic browpexy has proven to be a safe and effective option for the treatment of brow ptosis in lifting the upper third of the face. One of the initial steps in the procedure is the supposed hydrodissection of the periosteum from the skull at the brow using local anesthetic. The purpose of the study was to observe the actual behavior of the tissues, as well as to determine, if any, an ideal surgical method.
With a cadaveric specimen, this step of the procedure was simulated. Various dyes, needles, and surgical approaches were employed, then directly observed through tissue windows.
During this study we discovered that the periosteum was not actually dissected from the skull, but rather simply hydrated thus facilitating an easier separation of the periosteum from the underlying bone. Additionally, neither varying the position of the needle, the direction or method of approach, nor the type of needle utilized altered or improved the result in any appreciable manner.
The mechanism of hydrodissection of periosteum from the skull using local anesthetic was not observed to be true in this study, despite various needles and surgical approaches. Nevertheless, hydration of the periosteum did facilitate its separation from the skull, and should continue to be an initial step in endoscopic browpexy surgery.
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