Selective myotomy in forehead endoscopy.

Endoscopic forehead surgery in a subgaleal plane allows selective manipulation of the forehead and glabellar muscles in accordance with their influence in forehead and brow deformity. Myotomy begins by interrupting the blend of the fibers of the elevator and depressor muscles, thereby exposing the bone fixation and cutaneous insertions of the depressor muscles. Myotomy of the depressor group is performed by section of the muscle fibers as close as possible to their bone fixation, with release of the cutaneous insertions at the brow level. The involuntary frontalis contraction free from the active opposition of the depressor muscles and free from the restriction of the inelastic structure of the periosteum stabilizes the brow elevation and gives a natural, long-term result. No fixation methods are used to hold the forehead flap in position. Transverse section of the frontalis muscle is performed to restore brow symmetry or excessive lift of the brow.

Lower blepharoplasty through a biplanar flap / Retalho biplanar para blefaroplastia inferior

A byplanar flap, composed by cutaneous and muscular flaps with common musculocutaneous pedicle, is proposed to an adequate of the cutaneous and muscle excess in lower bepharoplasty. The byplanar flap allows to resect different quantities of the skin and muscle, in accordance to the palpebral deformity. It provides anappropriate vascular support, either for the cutaneous and for the muscular flap, through its common pedicle. The byplanar flap in association with the lateralcanthopexy promotes the recovery of the lower eyelid muscular sling with the lateral canthus and lower eyelid support. The resection and fixation of the muscular portion of the byplanar flap elevate the skin and muscle flaps together, providing the adequate correction of the excess of both tissues, decreasing the occurrence of scleral show or ectropion.