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DR. JOSEPH WALRATH - OCULOPLASTIC SURGERY - COORDINATOR 770-804-1684 EXT. 119 FAX 770-804-1679 PREOPERATIVE RISK ASSESSMENT / CLEARANCE FORM -- PLEASE COMPLETE WITHIN ONE MONTH OF THE SCHEDULED PROCEDURE -Dear Medical Doctor Thank you so much for your assistance in providing preoperative guidance and clearance Our patient would like to undergo the following procedure s Anesthesia Monitored General Duration hrs min Ideally I would like our patient to hold ASA for 2 weeks and related for 10...

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Hello this Dr. Joseph Wallah I'm going to describe for you today surgical technique to correct severeptosis called frontal is suspension and this technique the eyelid doesn't#39’t works the procedure relies on the nearby muscle which does work which is the Browne use the brow to enhance eyelid elevation the silicone rod is implanted into the eyelid and passed into the bro wand couples the brow to the eyelid more efficiently and therefore the brow becomes a more effective elevator of the eyelid the silicone rod is secured in this case with 5o polyester suture the position of the suture on the tarsal plate controls the contour of the eyelidpostoperatively this is secured in my technique with two 5o polyester horizontal mattress sutures as demonstrated in the video believe it's important to secure the silicone rod directly to the tarsal blade as opposed to passing it under the eyelid muscle blindly on to endow a needle because long-term the silicone rod can migrate you a tissue and lose its effectiveness find that anchoring it to the tarsal plate makes this much less likely the right needle is utilized to pass the silicone rod from the eyelid up into the stabbed incisions in the brow this is of course done quite carefully the passage should be deep so that the silicone rods are not visible externally when at all possible the only time they are visible externally is when the patient has Avery sunken eye configuration the rods are passed into the medial and lateralsuperciliary incisions of the brow and then they both exit through the central incision of the forehead and creating pentagonal configuration these Roger than secured to one another with a type70 retinal sleeve trim to size and secured at their final tension with some safety stitches of Marseilles to make sure that they don't loosen these stab incisions in the brow and forehead have never become a problem interns of scar visibility they fade rapidly and have always become very difficult to see Van Dan close inspection I have only seen these incisions become noticeable when they are all connected in a single line directly above the brow and therefore Do not choose this configuration for my suturing and my incision snow that the rod has been implanted tugging on the rod will lead to elevation the eyelid and this is the exact mechanism with which the patient will have more open eyes postoperatively these patients use excessive brow tone to get their eyelids up because otherwise they wouldn't#39’t be able to see and implanting the rod just makes them more effective at doing that this next step involved formation of a lid crease this is critical because most people with congenital posts don't have a lid crease, and it's a significant cosmetic improvement to give them one without this step the skin and the muscle billfold over the lashes I must give credit to Dr. Ted void know at Emory for instilling upon me the importance of this addendum to the technique careful closure of this incision is...

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