Lateral Brow Fixation in Endoscopic Forehead Lift: Long-Term Results with Braided Nylon Percutaneous Sutures

Abstract

Since the introduction of endoscopic forehead surgery, several fixation techniques have been described to remediate the fall of the lateral portion of the brow. Unfortunately, few studies demonstrate good long-term results with these methods. This study evaluates long-term results of a lateral brow fixation technique that uses two points in the lateral eyebrow: one in the distal extremity and another corresponding to the midpoint between the pupil and the lateral canthus of the eye. Transcutaneous fixation was performed using the Casagrande needle. Braided white nylon 2-0 suture was passed through the needle and retroceded without exiting the skin, catching the supraorbital adhesions. These sutures were fixed to the deep temporal fascia. A total of 44 patients underwent endoscopic forehead lift between March 2000 and March 2006. Pre- and postoperative forehead position was documented using photos and the Mirror (Canfield, NJ, USA) program. Through a line perpendicular to the interpupillary line, the following measurements were taken between the vertical center of the eyebrow and the (1) lateral canthus (2) midpoint between the lateral canthus and the pupil, and (3) pupillary midpoint. Three groups were studied: Group 1 (n = 32), evaluated at 1-1.5 years after surgery, Group 2 (n = 20), evaluated at 3+ years after surgery, and Group 3 (n = 8), evaluated at both 1-1.5 years and 3+ years after surgery. A student t test for Groups 1 and 2 and a Wilcoxon test for Group 3 indicated statistical significance. Through a solid evaluation method, our technique has demonstrated significantly good near- and longer-term results.