Correction Of Brow Ptosis Research Articles

Practice Patterns: An American Society of Plastic Surgeons (ASPS) Member Survey, 2000 and 2020-How Much Has Brow Lifting Changed?

In 2001, Elkwood and Matarasso published an American Society of Plastic Surgeons (ASPS) member survey detailing brow lift practice patterns. Interval changes in practice patterns have not been studied. The previous survey was revised to elucidate current trends in brow lift surgery. A 34-question descriptive survey was distributed to a random group of 2360 ASPS members. Results were compared to the 2001 survey. A total of 257 responses were collected (11% response rate; ± 6% margin of error at 95% CI). The most frequent technique for the correction of brow ptosis in both surveys was the endoscopic approach. The use of hardware fixation has increased in endoscopic brow lifting, whereas the use of cortical tunnels has decreased. Although coronal brow lifting has decreased in frequency, hairline and isolated temporal lift have increased. Neuromodulators have replaced resurfacing techniques as the most common nonsurgical adjunct. Frequent use of neuromodulators has risen from 11.2% to 88.5%. Nearly 30% of current surgeons feel that neuromodulators have replaced formal brow lifting procedures to a significant degree. In comparing the 2001 and current ASPS member survey there has been a clear transition to less invasive procedures over time. Although the endoscopic approach was the most popular means of forehead correction in both surveys, coronal brow lifting has decreased in frequency and the hairline and temporal approaches have increased. Neurotoxins have replaced laser resurfacing and chemical peeling methods as an adjunct, and in some cases replaced the invasive procedure entirely. Possible explanations for these findings will be discussed.

Practice Patterns, Part 2: An American Society of Plastic Surgeons (ASPS) Member Survey, 2000 and 2020. How Much Has Browlifting Changed?

PURPOSE: In 2001, Elkwood and Matarasso conducted an American Society of Plastic Surgeons (ASPS) member survey detailing browlift practice patterns. Despite significant changes in approach in the past twenty years, no survey has been performed since. METHODS: A 34-question descriptive survey was electronically distributed to a random group of 2,360 ASPS members. Results were then compared to the 2001 survey. RESULTS: A total of 257 responses were collected (11% response rate; ±6% margin of error at 95% CI). The most frequent technique for the correction of brow ptosis in both surveys was the endoscopic approach. The use of hardware fixation has increased in endoscopic browlifting while the use of cortical tunnels has decreased. While coronal browlifting has decreased in frequency, hairline and isolated temporal lift have increased. Neuromodulators have replaced resurfacing techniques as the most common non-surgical adjunct. Frequent use of neuromodulators has risen from 11.2% to 88.5%. Nearly 30% of current surgeons feel that neuromodulators have replaced formal browlifting procedures to a significant degree. CONCLUSION: In comparing the 2001 and current ASPS member survey there has been a clear transition to less invasive procedures over time. While the endoscopic approach was the most popular means of forehead correction in both surveys, coronal brow lifting has decreased in frequency while the hairline and temporal approaches have increased. Neurotoxins have replaced laser resurfacing and chemical peeling methods as an adjunct, and in some cases replaced the invasive procedure entirely. Possible explanations for the above will be discussed.

Extended Suprabrow Lift with Relief of Glabellar Wrinkles.

Eyebrows define one's facial appearance; brow ptosis, which can occur with aging, can convey a negative expression. Various methods have been used to correct eyebrow position and shape. We endeavored to repair brow ptosis and glabellar wrinkles and present the outcome. This retrospective study reviewed 40 patients who underwent extended suprabrow lift accompanied by relief of glabellar wrinkles between January 2018 and August 2020. The procedure was considered when patients exhibited brow ptosis, glabellar wrinkles, and a wide forehead. Fat graft was implemented after glabellar muscle division. The results were assessed based on measurements performed preoperatively and at 6 and 18 months postoperatively. Overall, patients were satisfied with the outcomes. To assess glabellar wrinkles, the Modified Fitzpatrick Wrinkle Assessment score revealed adequate correction during neutral and furrowed gazes (P < 0.05). The forehead and brow heights were also analyzed after repair, exhibiting decreased forehead height and elevated brow position (P < 0.05). At 6 and 18 months after surgery, adequate maintenance of the repair was evident (P < 0.05). A visible scar was observed in two patients, which was managed using a fractional ablative laser procedure. Extended suprabrow lift, when based on preoperative measurements, led to the correction of brow ptosis, glabellar wrinkles, and a wide forehead. For periorbital rejuvenation, it is imperative to decide locations where the skin and soft tissues should be preserved or removed. The use of fat grafts for wrinkle repair effectively maintains the repair postoperatively. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Upper eyelid blepharoplasty and associated ancillary procedures to improve cosmesis

To present combined procedures performed for cosmesis in patients with dermatochalasis who underwent upper lid blepharoplasty (ULB). This retrospective cross-sectional study evaluated patients who underwent ULB with associated surgical procedures from 2012 to 2016. Data were collected on patient demographics and types of procedures. The primary outcome measure was ancillary procedures combined with ULB. Data were analyzed for correlation. Statistical significance was defined as P<0.05. A total of 1,068ULBs were performed in 825 (86.3%) females and 131 (13.7%) males. The median age was statistically higher in males (P<0.001). Isolated ULB was performed in 296 (31%) patients, and correction of brow ptosis was the most common associated procedure (206/21.5%), followed by repair of eyelid ptosis (183/19.1%). The majority of patients required combined surgical procedures to correct periorbital involutional changes. A detailed preoperative evaluation is fundamental for choosing the appropriate surgical technique for each case, which can determine the final aesthetic result.

Endoscopic Brow Lift Fixation With Mitek Suture Anchors: A 9-Year Experience of a New "Ideal" Technique.

In recent years, the endoscopic technique has emerged as a minimally invasive approach to forehead rejuvenation, although the specific need for and mode of brow fixation for endoscopic brow lifts remain under considerable debate. An ideal fixation device should provide non-palpable long-lasting fixation and allow retention of the device post-operatively without the need for removal. It should also allow precise intraoperative adjustment for symmetry and correction of brow ptosis. The authors describe an endoscopic brow lift technique using an absorbable bone anchor, Mitek Microfix. A retrospective chart review was conducted in patients who underwent endoscopic brow lift procedures utilizing this fixation method at an academic practice. Outcomes evaluated included operative times, reoperation rates, palpability, fixation device permanence, incremental costs comparisons to conventional methods, efficacy, and technical learning curve. Complication rates were evaluated and the economic, incremental cost analysis of current fixation methods was reviewed. Eighty-two patients underwent single-procedure endoscopic brow fixation using the Mitek anchor over a 9-year period (2005-2014). The mean operative time was 100 minutes. There were no cases of implant palpability, alopecia, or other postoperative complications. Two patients underwent revision secondary lifts after an average of 5.5 months for temporal ptosis. The Mitek Microfix QuickAnchor provides durable, long-lasting fixation without device palpability. Its technical ease of use is demonstrated by the reasonable mean operative time achieved with the active involvement of resident surgeons. This device is operator-friendly, easy to use, fully indwelling, and provides lasting fixation without the development of palpability or alopecia.

Direct brow lift versus transblepharoplasty browpexy for correction of brow ptosis

Purpose The aim of this study was to compare direct brow lift and transblepharoplasty browpexy for the management of brow ptosis in terms of cosmetic results, complications, and patient satisfaction. Patients and methods It is a surgical intervention prospective comparative study, 40 brows of 24 patients with brow ptosis were divided into two groups. Group A included 20 brows that were subjected to direct brow lift and group B included 20 brows that were subjected to transblepharoplasty browpexy. Preoperative evaluation included assessment of general and ophthalmological history, brow evaluation, any associated dermatochalasis, ocular examination, cranial nerve examination, visual field assessment, and photographic documentation. Results Bilateral brow ptosis was present in 16 patients, whereas eight patients had unilateral brow ptosis. There were 16 female patients and eight male patients. Their age ranged between 53 and 75 years. The cosmetic complaint of an undesirable appearance was the presenting symptom in 18 patients, whereas functional issues with heaviness and temporal visual field defects were the presenting symptoms in four patients. In group A (direct brow lift), 16 brows were corrected with the brow level at or slightly above the superior orbital margin, whereas four brows were undercorrected. In group B (transblepharoplasty browpexy), 12 brows were fully corrected, whereas eight brows were undercorrected. Conclusion Both direct brow lift and transblepharoplasty browpexy are effective and safe techniques for the correction of brow ptosis. Each procedure has its own advantages.

Our Experience with Brow Ptosis Correction

Background: Brow elevation is one of the goals of surgical rejuvenation procedures. In this article, the authors reviewed their experience with brow lift, and they compared 4 different techniques: direct brow lift, brow lift with endotine ribbon device, brow lift with temporoparietalis imbrication, and brow lift with Mersilene mesh to provide long-lasting results. Methods: This is a retrospective study of 80 patients (20 for each group), aged between 48 and 75 years undergoing brow lift surgery, between January 2011 and January 2013. In all cases, the brow lift was associated with an upper blepharoplasty. The amount of brow elevation reduced was assessed by comparison of the preoperative and postoperative vertical distances between the superior eyebrow hairline and the midpupil and lateral and medial canthal angle. The average follow-up period was 18 months. Results: No incidences of infection, alopecia, or excessive scarring were noticed. The main complication associated with direct brow lift was visibility of the scar in 2 patients. One patient treated with brow lift with suture had recurrent eyebrow ptosis. Transient frontal paresthesia was noticed in 1 case treated with endotine ribbon device and in 1 case treated with Mersilene mesh, but this sensation returned by 6–12 weeks. Conclusions: In our experience, there does not exist a technique better than the other, but the best procedure depends on eyebrow contour, sex and age of the patient, magnitude of desired correction, presence or absence of patient’s hair, and patient’s expectations.

Comparison of satisfaction after direct browplasty in Asian patients with and without brow tattoo

ObjectiveTo determine patient-based scar assessment after direct browplasty for correction of brow ptosis between Asian female patients with and without brow tattoos. DesignA retrospective study with questionnaire via telephone interview. ParticipantsA total of 30 female Asian patients underwent direct browplasty from January 2008 to December 2011. MethodsThe Patient Scar Assessment Questionnaire (PSAQ) with 5 subscales including appearance, symptoms, consciousness, satisfaction with appearance, and satisfaction with symptoms was used at least 6 months after surgery in patients who underwent direct browplasty. PSAQ scores were compared between Group A (15 cases with brow tattoo lines) and Group B (15 cases without brow tattoo). A lower score indicates a favourable cosmetic outcome. ResultsOf the subscales of PSAQ, only “satisfaction with appearance” was significantly lower in Group A (1.4 ± 0.5) than in Group B (2.0 ± 1.0; p = 0.039). Mean scores of appearance, symptoms, satisfaction with symptoms, and overall scores were not different between 2 groups. ConclusionsAccording to the PSAQ, mean scores of appearance, symptoms, and consciousness regarding surgical scar after direct browplasty were relatively low. Asian patients who underwent direct browplasty were generally satisfied with overall appearance and comfort of their scar regardless of brow tattoo lines, despite the statistical difference in their satisfaction with appearance.

The “Power” Brow Lift: Efficient Correction of the Paralyzed Brow

Purpose. To describe a novel approach to brow ptosis correction and evaluate its long-term efficacy in patients with facial-paralysis-associated brow ptosis.Methods. Twenty-two patients aged from 50 to 90 years underwent “power” brow lifting, involving 3 intrabrow stab incisions and suture suspension of the brow to the frontal calvarium via titanium miniplate. Long-term results of the operation were assessed retrospectively. Pre- and postoperative photographs were measured with FACE-gram software to evaluate efficacy of the procedure.Results. Seventeen patients who underwent “power” brow lift were available for postoperative evaluation. Among them, follow-up length ranged from 12 to 448 days. The average post-operative change in brow height was 5.7 mm, which was statistically significant (). There were no complications.Conclusions. The “power” brow procedure can help to restore upper facial symmetry and visual fields and improve periocular hygiene. The operation is easily performed in an office setting, under local anesthesia, and appears to provide reliable long-term results. The time required to perform the procedure is far less than that required for a standard direct brow lift; there is no risk of postoperative forehead hypesthesia, and there is no superciliary scar.

Surgical Treatment of the Periocular Complex and Improvement of Quality of Life in Patients With Facial Paralysis

A devastating sequela of facial paralysis is the inability to close the eye. The resulting loss of corneal protection can potentially lead to severe consequences. Eyelid weight placement, lower eyelid suspension, and brow ptosis correction are frequently performed to protect the eye. We sought to measure and report the change in quality of life (QOL) after surgical treatment of the periocular complex, using the validated Facial Clinimetric Evaluation (FaCE) QOL instrument. From March 2009 to May 2010, 49 patients presenting to the Facial Nerve Center with paralytic lagophthalmos requiring intervention were treated with static periocular reanimation. Thirty-seven of the patients completed preoperative and postoperative FaCE surveys. Overall QOL, measured by the FaCE instrument, significantly improved following static periocular treatment. Mean FaCE scores increased from 44.1 to 52.7 (P < .001). Patients also reported a significant decrease in the amount of time their eye felt dry, irritated, or scratchy (P < .001). The amount of artificial tears and/or ointment also significantly decreased (P = .03). There were 2 cases of localized cellulitis with 1 eyelid weight extrusion. We report the first series of postoperative QOL changes following static periocular treatment for paralytic lagophthalmos. Patients report a notable improvement in periocular comfort and overall QOL.

Brow Ptosis Correction: A Comparison of Five Techniques

This study evaluates the effectiveness of five surgical techniques for brow ptosis repair including internal brow release (IBR), internal brow release with brow pexy (IBR + BP), internal brow release with corrugator and depressor supercilii removal (IBR + CDR), direct brow-lift (DB), and endoscopic brow-lift (EB). This is a retrospective study of 120 patients in which the preoperative and postoperative position of the medial, central, and lateral brow on both sides was measured. The brow was elevated 1.16 +/- 0.05 mm by IBR, 1.74 +/- 0.05 mm by IBR + BP, and 2.52 +/- 0.06 mm by IBR + CDR. IBR + BP was more effective than IBR in elevating the lateral brow ( P < 0.05). Removal of the medial brow depressors resulted in greater elevation of the medial and central brow than could be achieved with IBR or IBR + BP alone ( P < 0.01). EB resulted in the greatest amplitude of brow elevation (3.44 +/- 0.06 mm). Eyebrow-lifting surgery performed via the upper eyelid blepharoplasty incision prevents the lowering of brow position caused by blepharoplasty surgery alone. Brow pexy sutures are useful in enhancing elevation of the lateral brow, and removal of the medial brow depressors is useful in raising the medial and central brow.

An Original Application of the Endotine Ribbon Device for Brow Lift

Correction of brow ptosis and lateral temporal laxity is one of the goals of surgical rejuvenation of the aging face. The Endotine Forehead (Coapt Systems, Inc., Palo Alto, Calif.) device is an effective bioabsorbable fixation tool for forehead and brow-lift procedures. However, the Endotine Forehead device alone is not able to correct lateral brow ptosis and temporal laxity. In this article, the authors propose an innovative use of another special device, the Endotine Ribbon (Coapt Systems), to provide long-lasting results in lateral brow-lift surgery and temporal lateral laxity correction. Between February of 2006 and April of 2007, a total of 30 patients, aged between 38 and 70 years (average, 50 years), underwent brow-lift surgery. With this technique, the Endotine Ribbon is cut in halves and each portion of it is anchored to the deep temporal fascia with sutures, and its multiple tines facing outward grasp the superficial temporal fascia. The amount of brow elevation produced was assessed by comparison of the preoperative and postoperative vertical distances between the superior eyebrow hairline and the midpupil and lateral and medial canthal angle. The average follow-up period was 18 months. Using this technique, perfectly symmetric lateral eyebrows and temporal laxity correction were obtained in all patients. A lasting result was observed, and no significant adverse events were encountered. The application of the Endotine Ribbon for brow-lift procedures provides significant and reproducible lateral brow elevation and temporal laxity correction. This fixation method is effective, safe, and easy to use, and leads to high patient satisfaction.

Brow Lift via the Direct and Trans-Blepharoplasty Approaches

Brow ptosis occurs as part of the aging process, and as a complication of facial nerve paresis. The article addresses the options available for correction of brow ptosis. The direct brow lift is effective for medial and central brow ptosis, and additional lift laterally may occasionally be needed. This is achieved with either a temporal external lift or an internal lift combined with blepharoplasty. The direct brow lift is suitable for any degree and pattern of brow ptosis, usually in males. It is also suitable for older females as well as male patients with facial paresis or marked involutional brow ptosis. The trans-blepharoplasty brow lift is suitable for relatively small degrees of brow ptosis affecting mainly the lateral two-thirds of the brow in any age group. It is often combined with upper lid blepharoplasty and is performed through the same incision. Complications associated with the direct brow lift include a cosmetically disturbing scar, granuloma formation due to the use of braided absorbable sutures rather than monofilament sutures, and the brow descending again. There may be temporary patches of reduced sensation in the forehead which normally recover in a few months. Complications associated with the trans-blepharoplasty brow lift include less lift than desired, and sutures causing dimpling of the skin. These two techniques are useful additions to the approaches for patients with brow ptosis.

The Brow-Lift 1978

The direct brow-lift for correction of brow ptosis can be one of the most beneficial surgical procedures in cosmetic surgery. Careful preoperative evaluation and proper symmetrical marking of the correction are key elements for successful results. We discuss the surgical technique in detail.

Correction of Brow Ptosis

Brow ptosis should be corrected prior to a blepharoplasty. The superotemporal approach can be used, but the supraciliary incision is the preferred technique.