Brow Lift Technique Research Articles

Endoscopic Brow Lifts Über Alles

Innumerable approaches to the ptotic brow and forehead have been described in the past. Over the last twenty-five years, we have used all these techniques in cosmetic and reconstructive patients. We have used the endoscopic brow lift technique since 1995. While no one technique is applicable to all patients, the endoscopic brow lift, with appropriate modifications for individual patients, can be used effectively for most patients with brow ptosis. We present the nuances of this technique and show several different fixation methods we have found useful.

Current treatments for brow ptosis.

In this text, we describe and compare the most current brow-lifting techniques, including endoscopic, coronal, and pretrichial approaches, as well as subperiosteal and subgaleal dissection planes, and we discuss the advantages and disadvantages of each. Over the past decade, we have witnessed tremendous advances in the anatomic understanding of brow ptosis and in the procedures used to correct the resulting functional and aesthetic deformities.

Brow lift fixation

One of the more difficult and controversial aspects of forehead and brow lift is fixation with control and stabilization of the result. Aesthetic Surgery Journal has invited Robert W. Bernard, MD; Robert S. Hamas, MD; Peter McKinney, MD; and Malcolm D. Paul, MD to share their preferred brow lift techniques. Here are their responses to questions posed by “Comparing Notes” editor, Alan H. Gold, MD. ( Aesthetic Surg J 2003;23:217-219.)

National plastic surgery survey: brow lifting techniques and complications.

The purpose of this survey was to assess trends in brow lifting philosophy, techniques, and complications. This is the second of a three-part survey; the first part reported on complications with face lift techniques, and the final report will address practice management issues, including facility and ancillary procedures. Surveys were sent to 3800 members of the American Society of Plastic Surgeons; the response rate was 15 percent. This survey represents data on 6951 brow lifts, of which approximately 50 percent were performed endoscopically and 50 percent with a coronal incision. Several conclusions about the practice of the respondents were reached: (1) Both brow lift techniques were considered to be effective. (2) Surgeons considered coronal brow lifting to be more effective for the three basic goals of brow lifting: brow elevation, reduction of transverse lines, and reduction of glabellar lines. (3) Reported complication rates for both techniques were low, and the most frequent complication was alopecia (varying from 2.9 percent to 4 percent). (4) Patient satisfaction varied from 98.2 percent to 99.2 percent. (5) Major complications were rarely reported.

National Plastic Surgery Survey: Brow Lifting Techniques and Complications

National Plastic Surgery Survey: Brow Lifting Techniques and Complications

Refinement of the brow lift technique that does not raise the hairline

“Second Thoughts” focuses on ways in which aesthetic plastic surgeons have modified or even dramatically changed their techniques over time to achieve optimal results. Contributors are Aesthetic Society members and other recognized experts.

The subgaleal endoscopic browlift.

Most endoscopic browlifts are performed in a subperiosteal plane with or without fixation posterior to the hairline at the incision site. The extent and longevity of browlifting are variable and somewhat unpredictable. We reviewed the literature on endoscopic browlifting techniques and describe herein our technique for the subgaleal endoscopic browlift procedure. It differs from the published reports of subperiosteal endoscopic techniques in the plane of dissection, circumvention of a periosteal release, and suture fixation at the brow level. We have used this technique for browlifting in male and female patients alike, as well as in patients with preoperative brow asymmetries, with consistent results.

Esthetic facial surgery

In the last few years, aesthetic facial surgery--especially soft-tissue surgery--has received increasing attention, not only from the medical profession but also particularly from the media. This is due, in part, to the growing level of general acceptance of the formerly stigmatized issue of aesthetic surgery, and in part to increasing patient expectations. Moreover, the introduction of less invasive procedures with outstanding long-term results have brought about a considerable change in aesthetic surgery. A comprehensive account of face lifting, forehead lifting, brow lifting, blepharoplasty, cervical liposuction and adjuvant techniques of skin rejuvenation will be given and discussed.

Endoscopic Foreheadplasty: A Histologic Comparison of Periosteal Refixation after Endoscopic versus Bicoronal Lift

Endoscopic brow lift techniques using temporary fixation rely on rapid readherence of the periosteum to calvarial bone. Little is known about the histologic events that occur during the early postoperative period after these procedures. An animal study was designed to compare and contrast periosteal fixation to bone and unelevated periosteum, with endoscopic and bicoronal brow lift techniques. One method of temporary fixation is the use of absorbable (polylactic/polyglycolic acid copolymer) LactoSorb screws; a histologic analysis of implanted LactoSorb screws was also performed. Sixteen rabbits underwent brow lifts; eight underwent endoscopic brow lift and fixation with LactoSorb screws without skin excision, and another eight underwent traditional bicoronal brow lift with skin excision and closure under tension. Animals were killed 1, 2, 6, and 12 weeks after the procedures were performed to evaluate the interaction of periosteum and bone and the normal, unelevated periosteum/calvarium interface at a site distant from the operative area. Histologic specimens were examined for the degree of apposition of periosteum to bone and for any fibrous or bony reaction at this interface. Histologic analysis showed various degrees of periosteal fibrosis and fixation to calvarial bone. After an initial phase of minimal periosteal adherence and moderate inflammation, the periosteum became progressively more adherent to bone in both groups, with no significant differences between treatment groups in rates of fixation. Fixation required at least 6 weeks. LactoSorb screws were surrounded by an area of mild inflammation and were progressively hydrolyzed and digested. Periosteal fixation increases over time for bicoronal and endoscopic brow lifts with minimal differences between the two techniques. With this animal model, periosteal adherence to calvarium requires at least 6 weeks with complete adherence by 12 weeks. In addition, the use of absorbable fixation screws seems to be both effective and well tolerated. The histologic changes associated with periosteal healing observed in this study suggest that permanent or semipermanent fixation may improve the accuracy and early postoperative maintenance of forehead advancement.

Aesthetic oculoplastic surgery.

Important concepts and advances continue to evolve in the field of aesthetic oculoplastic surgery. A keen interest in aesthetics exists, both on the part of the youth-oriented, aging baby-boomer population and on the part of many physicians and surgeons in a variety of different specialities. This review article highlights recent, important developments regarding cosmetic Botox injections for lines of facial expression, laser facial-resurfacing techniques, endoscopic and updated browlift techniques, lower-lid blepharoplasty with suborbicularis oculi fat lift, and subcutaneous Gore-Tex implants for treatment of deep facial rhytids. Because of the space limitations of this review, it is not possible to include a thorough step-by-step description of all surgical techniques. Rather, important concepts, references, and updates are emphasized. The information presented should be of interest to readers of varying levels of expertise.

Laser-assisted endoscopic forehead lift

The periorbital area is one of the most expressive areas of the face, and there are many techniques available that can be used to alter the position of the eyebrows. Traditional surgical browlift techniques use coronal, midforehead, and direct approaches. This article discusses one of the most recent innovations in forehead lifting, the laser-assisted endoscopic forehead lift. A review of the literature describes the numerous available surgical techniques used to change the position of the eyebrow. The surgical technique for the laser-assisted endoscopic forehead lift is then presented in detail and illustrated with the results of two cases.

Modified brow lift: An adjunct to blepharoplasty

Purpose: This report evaluates the efficacy of the modified supratrichial brow lift technique. The indications for the procedure, as well as the advantages, effectiveness, and complications are reviewed. Patients and Methods: Thirty-six modified supratrichial brow lift procedures were performed bilaterally on 34 female and two male patients. The procedure was used in conjunction with a blepharoplasty in 32 patients and alone in four patients. Results: The procedure improved the cosmetic result in the 32 patients with lateral brow ptosis who had a concomitant upper eyelid blepharoplasty. No complications were encountered. Conclusion: The modified supratrichial brow lift can improve the cosmetic result in patients with lateral brow ptosis undergoing an upper eyelid blepharoplasty.

Surgery of the Aging Face

The following represent some of the highlights presented concerning surgery of the aging face at the Fifth International Symposium of Facial Plastic Surgery in Toronto, Canada, on June 28, 1989. Norman J. Pastorek, MD, New Rochelle, NY, presented a paper entitled, Refinements of the Rafaty Brow Lift. The author defined improvements of the original Rafaty direct browlift technique, with emphasis on incision placement, elevation of the orbicularis muscle, and meticulous three-layer closure technique. Clinical indications and possible complications were also discussed. Douglas D. Dedo, MD, West Palm Beach, Fla, presented a paper entitled vs Sub-SMAS Facelift. Dr Dedo reviewed 117 facelift procedures over a 5-year period. Included in this series were two patients who had received a sub-SMAS elevation and advancement procedure on one side and a SMAS plication procedure on the other. Dr Dedo was unable to clinically distinguish between the two sides 5 years postoperatively. Based on these observations, Dr Dedo suggests that plication may be just as effective in the long term as SMAS elevation and advancement.