Endoscopic Brow Lift Research Articles

Browlift – A South East Asian Experience

Background:To describe the indications, techniques and outcomes of various browlift procedures in a predominantly East-Asian community.Patients and Methods:Retrospective review of patients who underwent browlift procedures performed by 2 oculoplastic surgeons or under their direct supervision, in a tertiary referral hospital in South East Asia from 2002 to 2007.Results: Forty-six patients (30 female, 16 male) had browlift surgery for 89 sides from 2002 to 2007. Mean follow-up period was 10 months (6 to 44 months). 43 patients had bilateral browlift, 3 patients had unilateral browlift, 2 of whom had underlying facial nerve palsy and one had involutional brow ptosis. Indications: involutional brow ptosis (42), mitochondrial myopathy (2), and facial palsy (2). Ethnicity of patients: Chinese (40), Indian (4) and Malay (2). Techniques: direct browlift (18), transblepharoplasty browpexy (6), midforehead lift (3), coronal browlift (2) and pretrichial browlift (4), endoscopic browlift (7), limited incision nonendoscopic browlift (5) and temporal browlift (3). Adjuvant procedures included upper blepharoplasty (26), blepharoptosis correction (4), midface lift (2), upper eyelid entropion correction (1), lacrimal gland fixation (1), and upper lid gold implant (1). Encountered complications included: undercorrection 6 (12%), segmental facial nerve palsy 1(2%), visible scar 2 (5%), paraesthesia 2 (5%), suture granuloma 1 (2%). Overall 94% of our patients were satisfied.Conclusion: Browlift provides satisfactory results for both patient and surgeon. A comprehensive knowledge and proper surgical technique, along with a thorough discussion with patients about the pros and cons of each procedure are essential to obtain optimal outcomes.

Aesthetic Plastic Surgery Symposium, Toronto, Ontario, April 17–18, 2009

Dr Walter Peters, Course Director, and the University of Toronto hosted the annual symposium and Dr WRN Lindsay, our founding plastic surgeon, attended. Dr Grady Core, Dr Mark Jewell and Dr Renate Saltz were our visiting professors in addition to local speakers. This reporter noted many things of interest although it is not possible to mention them all or to attribute each to individuals. There is a trend to analyse augmentation mammaplasty to attempt to better predict outcomes and the incidence of reoperations; for example, choosing textured implants for shaped devices and smooth implants for augmentation mastopexy. Dr Saltz said shape was more important than the scar in mastopexy. Patients will accept the scar if the shape is good and long lasting and the superior pedicle or medial pedicle is useful. If the inferior pedicle is used it can be used to augment the upper pole. Dr Lista said surgery can be done faster with an improvement in quality noting that lessons can be learned from successful car manufacturers such as Toyota, the key being organization, repetition, staff training and planning. Surgical quality is now better in private clinics than in general hospitals. Sadly, general hospitals have no way to catch up because they are working on an old-fashioned model and show few signs of moving toward the future. Larger volumes mean better quality as surgery changes from the craft model, where every operation is different, to the assembly line idea, where similarities are stressed. This can be done while retaining patient personal contact and ultimately, results will speak for themselves. Ontario now spends 46% of tax revenue on health care. As revenues decrease there will be a squeeze, necessitating the adoption of new delivery models. Surgical dissection and cautery using ultrasound is on the horizon but expensive. This allows dissection without heat or smoke. Dr Core presented abdominal wall reconstructions advising the use of very wide mesh. It was noted that the complications of TRAM flaps seem to be under-reported by some. Dr Peters presented a fascinating history of injectibles. These have been widely used around the world and despite cautions and in some jurisdictions illegal (eg, silicone injections), are still being done. ‘Permanent fillers’ need to approached with caution because some develop inflammatory reactions many years later and are difficult to treat. In the past 20 years, a new class of injectible fillers has been widely used in Ukraine, Russia and China – polyacrylamide hydrogel. History has a repeated itself. As of May 2006, the Chinese Food and Drug Administration has banned its use. Drs Ford and Core presented midface rejuvenation using the lower eyelid approach by relocating lower lid fat and elevating the malar fat fad. This produces a good result without a preauricular incision, and has an acceptable recovery period. Dr Core is pleased with the transaxillary augmentation under visualization and can insert up to a 300 mL low-profile gel implant this way. The simplest incision is likely the best. Cosmetic medicine is a growth field, fuelled by lowering of insurance payments and family doctors diversifying. There was much discussion on the advantages and disadvantages of broadening one’s practise to increase traffic flow through one’s clinic. During the recession surgery seems down or postponed, but injectibles and medical aesthetics seem strong. Income sharing seems an important motivator and practice stabilizer and can lead to inequities, with nurses earning less than estheticians. A new initiative will remind the public that plastic surgeons are best qualified to do all cosmetic procedures for the safety and benefit of patients. Dr Jewell thinks the minimal access cranial suspension face-lift is a good procedure, but takes practice. The neck can be improved in some patients without much neck dissection and the three sutures are safe. The skin is released after the suture if irregularities are seen. The level of lift is vertical in front of the ear, which means a shorter scar behind the ear. It moves volume back up into the cheek. He likes size 0 PDS absorbable sutures. Dr Saltz told us abdominoplasty can be improved by suction of the sides and back before abdominoplasty then limiting the dissection lateral to the rectus abdominus. Dissection of the flap superficially, preserving perforators, is of help. Obesity and combining operations increase the complication rate. Dr Core said the key to endoscopic brow lift is fixation. The use of endoscopy seems to be waning likely due to the expense of equipment. He does midface lifts through the lower eyelid using a skin-muscle flap and elevates the malar fat pad, inserting the orbital fat pad into the naso-jugal groove. He also elevates the orbicularis oculi. The meeting was well attended and a large turnout of nurses was noted.

The Modified Lateral Brow Lift

In the aging face, the lateral third of the brow ages first and ages most. Aesthetically, eyebrow shape is more significant than height and eyebrow shape is highly dependent on the level of the lateral brow complex. Surgical attempts to elevate the brow complex are usually successful medially, but often fail laterally. The "modified lateral brow lift" is a hybrid technique, incorporating features of an endoscopic brow lift (small hidden incisions, deep tissue fixation) and features of an open coronal brow lift (full thickness scalp excision). Sensory innervation of the scalp is preserved and secure fixation of the elevated lateral brow is achieved. Side effects and complications are minimal.

Depressed Anterior Table Fracture: A Minimally Invasive Method of Reduction

One-third of frontal sinus fractures are isolated to the anterior table. Traditional approaches to the reduction of an isolated anterior table fracture include the coronal incision, the bilateral brow incision, an endoscopic brow lift with an incision either directly over the fracture or in the brow, and delayed repair with a camouflaging implant. We describe a case involving a 14-year-old boy with a depressed anterior table fracture that we successfully treated using a minimally invasive technique requiring only one 2-cm incision.

The Case for Open Forehead Rejuvenation

To review the role of open forehead procedures in upper-face rejuvenation. The clinical records of consecutive patients undergoing a coronal or trichophytic brow-lift from July 1, 1993, to June 30, 2005, were reviewed. Patient demographics and complication rates were tabulated and compared with published rates for endoscopic brow-lifts. Patient questionnaires were sent to correlate subjective outcome measures with objective clinical record data. To obtain population-based perceptions, 200 women aged 30 to 70 years were surveyed at a local mall. A total of 628 coronal and 376 trichophytic forehead-lifts were performed for which there were clinical records. There were 6 revisions (0.57%), no hematomas, 12 cases of permanent numbness (1.20%), 7 cases of permanent alopecia (0.70%), and no cases of permanent frontal branch weakness. The adjusted response rate for the questionnaire was 64.0% (416 of 650). Open procedures in this series had a complication rate equal to or lower than published rates in endoscopic brow-lift series. Open brow-lift procedures are an effective means of upper-face rejuvenation and, when performed correctly, demonstrate high rates of patient satisfaction.

Excision of Benign Lesions of the Forehead and Malar Regions Utilizing Endoscopic Browlift Techniques

•Endoscopic browlift techniques can be applied to the excision of a variety of benign lesions in the forehead and malar regions •Requires careful pre-operative planning •Surgeon must have precise knowledge of fascial planes •Such methods offer several advantages without compromising therapeutic outcome •Complete excision of lesion •Favorable post-operative course and outcome •Preservation of important neural and vascular structures •It may not be appropriate to use these limited access approaches for resecting malignant or recurrent lesions •Exposure adequate for excising lesion but limits dissection of surrounding tissue Introduction

Determination of Shear Strength of Periosteum Attached to Bone With BioGlue Surgical Adhesive

To determine the shear strength of BioGlue Surgical Adhesive (Cryolife Inc, Kennesaw, Georgia) for use in periosteal fixation in endoscopic browplasty. In a controlled design, the shear strength of periosteal attachment to native bone and that of dissected periosteum affixed to bone with BioGlue surgical adhesive was physiologically determined. Twenty-one periosteum and bone samples were harvested from 3 human cadavers. These samples were tested for maximum shear strength using an Instron Model 5500 universal materials testing machine. Native samples consisted of periosteum still attached to the bone surface, while BioGlue samples consisted of dissected periosteum reattached to the bone surface using BioGlue surgical adhesive. The maximum shear strength attained for each sample was recorded and used to determine if native samples differed from those using BioGlue surgical adhesive. The mean (SD) maximum shear strength values obtained during testing were 57.8 (31.7) kPa and 45.9 (27.4) kPa (589.4 [323.3] gram force [gf]/cm(2) and 468.0 [279.4] gf/cm(2)) for native (n=8) and BioGlue (n=9) samples, respectively. There was no statistical difference between the native and BioGlue samples (P> .05) using analysis of variance. This study demonstrates that the adhesive properties of BioGlue are similar to the strength of attachment of native periosteum to bone and supports the use of BioGlue as an alternative method of fixation for use in endoscopic brow-lifting.

Preliminary Evaluation of a Fast-Absorbing Multipoint Fixation Device

Since the Endotine forehead fixation device (Coapt Systems, Palo Alto, CA) was introduced in 2003, a small percentage of surgeons and patients have complained of persistent palpability and sensitivity related to its 12- to 15-month absorption time. Therefore, a refinement of the original design, the Ultratine (Coapt Systems), consisting of a polymer blend altered for faster absorption and biodegradability, was introduced in 2006. The authors report early results of fixation using the Ultratine with respect to permanence of elevation and the duration of visibility, palpability, and sensitivity of the implant. The authors conducted a retrospective review of patients who had undergone brow lift with Ultratine forehead fixation, along with concomitant cosmetic procedures. Ten patients were available for follow-up at 14 months postoperatively. In many cases, the implant biodegraded and absorbed at the 3- to 6-month intervals, and symptoms of visibility, palpability, and sensitivity were markedly improved over the original Endotine device. The Ultratine degradation profile produces secure, permanent fixation and elevation for endoscopic brow lifts while diminishing the long-lasting side effects of visibility, palpability, and sensitivity exhibited by a small proportion of patients with the original Endotine device. It is an option particularly for those patients who have thin scalps or fine hair. The Endotine may still be the best choice for patients with heavier brows; tighter, more immobile brows; and for secondary cases. It may also be preferable in cases of reverse brow procedures intended to lower the hairline.

Multispecialty Contralateral Study of Clinical Experience With the Ultratine Forehead Fixation Device: Evolution of the Original Endotine Device

Multispecialty Contralateral Study of Clinical Experience With the Ultratine Forehead Fixation Device: Evolution of the Original Endotine Device

Frontal Cranioplasty: The Endoscopic Approach

Sir: Advantages of the endoscopic approach to brow repositioning have led to a greater acceptability of this procedure among cosmetic patients. It is also being used increasingly in reconstructive procedures, including trauma, tumor resection, and craniotomy. While open coronal approaches remain the accepted standard, a limited number of reports have been published concerning endoscopic forehead recontouring. We present a 40-year-old woman with significant forehead contour irregularities following bifrontal craniotomy for resection of a pituitary macroadenoma. Her primary complaints were a change in her appearance and limited forehead motion. On physical examination she was noted to have a well-healed bicoronal incision with visible and palpable bilateral vertical defects over her forehead osteotomy sites. In addition, there was significant contraction of her frontalis muscle with limited bilateral brow movement (Fig. 1, left).Fig. 1.: Preoperative and postoperative views of the endoscopic cranioplasty procedure. This procedure was combined with an endoscopic brow lift. Note the improvement in the bony contour of the forehead.Using endoscopic techniques, a subperiosteal dissection was accomplished using five small incisions. The temporal incisions were used to create a flap just above the superficial layer of the deep temporal fascia that joined the center subperiosteal flap through the temporal line. The forehead soft tissues were lifted completely from the arcus marginalis. Once the flap was elevated, the vertical frontal bone defects were well visualized. The bilateral defects were filled with 10 cc of Norian bone cement (Synthes Corporation, Paoli, Pa.) using a beaver-tail elevator as a spatula. Standard elevation of the brow was accomplished with bone- anchored sutures, and a temporal lift was performed (Fig. 1right). Cranioplasty is particularly amenable to the endoscopic approach given the ease with which a subperiosteal flap can be elevated. Recently, successful case reports of endoscopic forehead recontouring have been published using different contour techniques, including power rasps and burrs,1 expanded polytetrafluoroethylene,2 hydroxylapatite,3 and calcium phosphate cement.4,5 These reports differ from ours, however, as to the type of defect repaired, the placement, number, and types of incisions, and the type of graft used. Temporal access incisions allow easy exposure to the lateral forehead deformities bilaterally as well as easier insertion of the bone graft. They also allow for possible bone rasping if necessary. With respect to our choice of synthetic bone graft, we used a calcium phosphate cement paste (Norian). The advantages of Norian bone cement include avoidance of donor-site morbidity, a smaller structure than synthetic hydroxylapatites (which results in better remodeling), and an isothermic reaction upon application. We found that forehead recontouring is particularly amenable to the endoscopic approach. There are some unique differences when using this technique for cosmetic versus reconstructive purposes. The reconstructive approach may involve elevating over hardware, elevating over irregular bone surfaces, and dissecting in previously dissected planes. However, these differences had no effect on the final results and were challenges that were easily overcome. With proficiency in endoscopic cosmetic brow lifting, this approach is easily applied in reconstructive cases, providing patients with a less invasive option. Jeremy Warner, M.D. Department of Surgery Division of Plastics Surgery University of Wisconsin Madison, Wis. Tom D. Wang, M.D. Department of Otolaryngology Division of Facial Plastic Surgery Oregon Health Sciences University Portland, Ore. Benjamin C. Marcus, M.D. Department of Surgery Division of Facial Plastic Surgery University of Wisconsin Madison, Wis.

Endoscope-Assisted Temporoparietal Fascia Harvest for Auricular Reconstruction

Reconstruction of microtia may require a temporoparietal fascia flap. The authors modified existing endoscopic temporoparietal fascia harvest techniques and applied them to auricular reconstruction to reduce incision size, scarring, and visible alopecia. Flap design was altered to include posterior occipital circulation to improve perfusion and decrease venous congestion. Cases of open and endoscope-assisted auricular reconstruction techniques have not been compared in the literature. Seventeen patients underwent Medpor auricular reconstruction with temporoparietal fascia flaps (eight open and nine endoscope-assisted). Physical outcome (scar size, location, appearance, and complication rate), flap size, surgical times, and blood loss were compared. Equipment and dissection techniques are reviewed. No flap complications occurred with either group. Endoscope-assisted incision length was 18 to 25 mm, compared with 150 to 200 mm using the open technique. No significant alopecia was noted in the endoscopic group, whereas most open patients had visible alopecia. Open surgical time averaged 325.9 minutes, and endoscopic surgical time averaged 276.5 minutes. Estimated blood loss averaged 56.3 cc for open and 45.6 cc for endoscopic procedures. Open temporoparietal fascia flap size averaged 8.87 x 9.75 cm, whereas endoscopic temporoparietal fascia flap size averaged 7.9 x 10.2 cm. Standard endoscopic brow-lift instruments were used. The optimal superior access port placement was the upper one-third/lower two-thirds junction of the flap. The endoscope-assisted temporoparietal fascia harvest technique for auricular reconstruction can minimize scarring, alopecia, and surgical time, with comparable blood loss. Flap size is comparable to that of the traditional open approach. The authors recommend a broadly based pedicle instead of one based solely off the superficial temporal artery.

Use of Triple-Convergence Polypropylene Thread™ for the Aesthetic Correction of Partial Facial Paralysis

Rehabilitation and reanimation of the paralyzed face remains a challenge. A variety of autografts and allografts have been used for static facial suspension. We report two cases of long-standing partial facial paralysis treated with 3C triple-convergence polypropylene thread. A 39-year-old woman with right-sided partial facial paralysis underwent an endoscopy-assisted facial suspension using the 3C threads and a 60-year-old woman with right-sided partial facial paralysis underwent a round face-lifting combined with endoscopic brow lift and placement of 3C triple-convergence polypropylene threads. Its use for partial facial paralysis has not been previously described. The 1-year follow-up shows effective preservation of the surgical result and patient satisfaction.

Percutaneous Suture Suspension Brow Lift

Background: Endoscopic brow lift and brow suspension have been combined to create a new minimal access brow lift that addresses key elements in forehead rejuvenation. Anatomical studies have focused on the importance of lateral brow repositioning and maintenance of the medial retaining ligaments to create a natural, appealing brow lift. Method: The authors describe the percutaneous suture suspension brow lift (PSSBL) technique for upper periorbital rejuvenation and their experience using the technique. The PSSBLs were performed in 25 patients during a 2-year period. Twelve patients had a brow lift in conjunction with an upper blepharoplasty. Of these, 3 patients had only a periorbital rejuvenation by brow lift and blepharoplasty. Twelve cases had only a brow lift for rejuvenation of the periorbital region along with other facial rejuvenation procedures. One patient had a unilateral brow lift to correct posttraumatic asymmetry. Results: All patients were seen for at least 3 postoperative visits extending to an average of 12 months postoperatively. Two patients underwent a redo procedure because of breakdown of sutures. There were no cases of postoperative brow asymmetry except in those in whom a redo had to be performed. Conclusions: The PSSBL is a safe and technically simple technique that helps achieve optimal esthetic results in brow lift with few complications and a high patient acceptance rate.

Full-Face Carbon Dioxide Laser Resurfacing: A 10-Year Follow-Up Descriptive Study

The purposes of this study were to retrospectively compare the 1-, 5-, and 10-year cosmetic outcomes of full-face carbon dioxide laser resurfacing using the SilkTouch technology, and analyze its advantages, disadvantages, and long-term results. Photographic results of full-face carbon dioxide laser resurfacing were evaluated after 1, 5, and 10 years. Statistical analysis considered surgeon and patient satisfaction based on a predetermined cosmetic visual analogue scale. Patients and two plastic surgeons unfamiliar with the cases evaluated objective postresurfacing results using Beausang's grading system and a modified wrinkle assessment scale. One hundred fifty-nine patients were treated and 46 patients completed 1-, 5-, and 10-year follow-up. Combined aesthetic procedures to the full-face carbon dioxide resurfacing were transcutaneous upper lid/lower lid transconjunctival blepharoplasty and endoscopic brow lifts in 15 patients. After 1 year, some relapse occurred, but the overall aesthetic result remained very good. At 5 and 10 years, respectively, 32 and 20 percent of the sample maintained good-quality skin texture; 22 and 19 percent achieved correction of skin pigmentation without scars; and 88 and 98 percent needed correction of recurrent rhytides, jowling, and redundant skin. Permanent hypopigmentation was found in four cases (8.7 percent). The authors' early experience with the carbon dioxide laser was excellent, but after 1 year, they noticed lines of demarcation between treated and nontreated skin or persistent erythema. After 5 and 10 years, advantages were maintenance of good skin texture, ablation of fine wrinkles, and long-term correction of skin pigmentation. Disadvantages included permanent hypopigmentation of the mandible-neck junction, telangiectasia, and possible accentuation of skin redundancy.

Suture Fixation Technique for Endoscopic Brow Lift

Endoscopic brow lift has become widely accepted as a procedure for restoring a youthful brow, as only three, hardly noticeable incisions of the scalp are needed for this subperiosteal dissection and final repositioning of the brow. It has become an acceptable technique, an alternative to the conventional technique or transcoronal browpexy. Endoscopic brow lift allows separation and repositioning of the periosteum of the orbital rims and zygomaxilla. In a 7-year period beginning September 1999, 350 patients underwent endoscopic brow lift. In these patients, we used our fixation approach, which was accomplished with an absorbable suture subperiosteally. Satisfactory forehead rejuvenation was obtained in all patients with correct eyebrow movement. Long-term results over 7 years confirm the strength and durability of our fixation approach. We consider this approach to be a simple, fast, and reliable fixation technique that establishes precise, secure, and direct brow fixation that allows satisfactory and long-lasting cosmetic results.

Endoscopic Periosteal Brow Lift: Evaluation and Follow-Up of Eyebrow Height

Endoscopic brow lift has become widely accepted as a method for rejuvenation of the upper third of the face, mainly to achieve eyebrow elevation. In this study, the authors quantified eyebrow elevation after videoendoscopic subperiosteal technique and followed up the heights of the eyebrows at different postoperative intervals. Seventy-two patients were submitted to endoscopic subperiosteal brow lift, and photographic evaluation was performed preoperatively and at different intervals postoperatively. From an interpupillary line, three different measurements on each side were obtained up to the superior border of both eyebrows. The distance between the medial eyebrows was also measured. Results were analyzed statistically by using the t test. Comparing preoperative values and those obtained at 5 months postoperatively, significant augmentation in medial, central, and lateral height of both eyebrows was noted (p < 0.05). Analyzing a group of 38 patients with mean postoperative times of 8.5 and 3.5 months, it was noted that there is spontaneous and significant augmentation in the medial height of both eyebrows (p < 0.05). A third group (24 patients) was analyzed at mean postoperative times of 3.5 and 24 months. The later follow-up showed continuous and significant elevation of the medial, central, and lateral height of both eyebrows (p < 0.05). The distance between medial eyebrows did not show any statistical difference. Subperiosteal endoscopic brow lift showed clinical and statistical effectiveness in correcting eyebrow ptosis, promoting also a spontaneous and progressive elevation of eyebrows, without enlarging the interbrow distance.

Endoscopic Brow Lift, Upper and Lower Blepharoplasty, Retinacular Canthopexy: Personal Approach

Coconut Grove, Fla. Baker Gordon Cosmetic Surgery Video Series Received for publication July 13, 2007; accepted July 20, 2007. Presented at the 41st Annual Baker Gordon Symposium on Cosmetic Surgery, in Miami, Florida, February 15 through 17, 2007. Video Plus content is available for this article. A direct URL citation appears in the printed text; simply type the URL address into any web browser to access this content. Clickable links to the material are provided in the HTML text and PDF of this article on the Journal’s Web site (www.PRSJournal.com). James M. Stuzin, M.D., 3225 Aviation Avenue, Suite 100, Coconut Grove, Fla. 33133, [email protected]

S234: Evaluation and Rejuvenation of the Upper Facial Third

Cosmetic surgery is now a fundamental part of an oral and maxillofacial surgeon’s training. In fact, proficiency in cosmetic surgery follows the OMS’s experience with trauma management and orthognathic surgery, and is included in the same section of the American Board of Oral and Maxillofacial Surgery’s oral certification examination.The number of people undergoing cosmetic surgery is increasing at an amazing rate worldwide. What used to be a “secret” luxury for only the extremely wealthy, has now become socially acceptable and available to the vast majority of men and women. As such, it can be expected that the oral and maxillofacial surgeon will find cosmetic surgery to be a growing percentage of his or her practice.With cosmetic surgery being a rapidly changing and evolving field, it is imperative that the maxillofacial surgeon continue his or her studies in order to remain current. This course will employ the most current methods of assessing and evaluating the upper face and it’s relation to the remainder of the head and neck. Relevant anatomy will be reviewed and emphasis will be placed on avoiding pitfalls by way of thorough pre-operative evaluation.The indications, contraindications, risks, benefits, and alternatives of various treatment options including brow and temporal lifting, skin resurfacing, and the use of botulinum toxin and filler materials will be discussed. This will be followed by discussion of the necessary elements of a thorough pre-operative work-up.Next, the details of performing a contemporary endoscopic browlift and upper eyelid blepharoplasty will be discussed, with emphasis being placed on avoiding complications. Finally, details of post-operative care will be reviewed including the identification and management of complication. Cosmetic surgery is now a fundamental part of an oral and maxillofacial surgeon’s training. In fact, proficiency in cosmetic surgery follows the OMS’s experience with trauma management and orthognathic surgery, and is included in the same section of the American Board of Oral and Maxillofacial Surgery’s oral certification examination. The number of people undergoing cosmetic surgery is increasing at an amazing rate worldwide. What used to be a “secret” luxury for only the extremely wealthy, has now become socially acceptable and available to the vast majority of men and women. As such, it can be expected that the oral and maxillofacial surgeon will find cosmetic surgery to be a growing percentage of his or her practice. With cosmetic surgery being a rapidly changing and evolving field, it is imperative that the maxillofacial surgeon continue his or her studies in order to remain current. This course will employ the most current methods of assessing and evaluating the upper face and it’s relation to the remainder of the head and neck. Relevant anatomy will be reviewed and emphasis will be placed on avoiding pitfalls by way of thorough pre-operative evaluation. The indications, contraindications, risks, benefits, and alternatives of various treatment options including brow and temporal lifting, skin resurfacing, and the use of botulinum toxin and filler materials will be discussed. This will be followed by discussion of the necessary elements of a thorough pre-operative work-up. Next, the details of performing a contemporary endoscopic browlift and upper eyelid blepharoplasty will be discussed, with emphasis being placed on avoiding complications. Finally, details of post-operative care will be reviewed including the identification and management of complication.

Efficacy and Safety of Endotine Fixation Device in Endoscopic Brow-Lift

Archives of Facial Plastic SurgeryVol. 9, No. 3 Editor's Correspondence: Research LettersEfficacy and Safety of Endotine Fixation Device in Endoscopic Brow-LiftPatrick J. ByrnePatrick J. ByrneCorrespondence: Dr Byrne, Department of Otorhinolaryngology–Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University Hospital, 601 N Caroline St, JHOC, Sixth Floor, Baltimore, MD 21287-1910 E-mail Address: pbyrne2@jhmi.eduSearch for more papers by this authorPublished Online:1 May 2007https://doi.org/10.1001/archfaci.9.3.212AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited byMultispecialty Contralateral Study of Clinical Experience With the Ultratine Forehead Fixation Device: Evolution of the Original Endotine Device David B. Apfelberg, James Newman, Miles Graivier, Mark A. Petroff, and Richard Levine1 July 2008 | Archives of Facial Plastic Surgery, Vol. 10, No. 4Safety of Surgeon-Directed Conscious Sedation in Nasal Surgery Brandon A. Van Noord and Craig L. Cupp1 July 2008 | Archives of Facial Plastic Surgery, Vol. 10, No. 4 Volume 9Issue 3May 2007 InformationCopyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.To cite this article:Patrick J. Byrne.Efficacy and Safety of Endotine Fixation Device in Endoscopic Brow-Lift.Archives of Facial Plastic Surgery.May 2007.212-214.http://doi.org/10.1001/archfaci.9.3.212Published in Volume: 9 Issue 3: May 1, 2007PDF download

Limited Incision Nonendoscopic Brow Lift

The authors compared the nonendoscopic brow lift technique to the popular endoscopic procedure to determine whether it offers a less complex and less expensive but equally effective alternative. A retrospective comparison of the senior author's experience with the endoscopic brow lift (100 patients; years 1999 to 2004) and the nonendoscopic brow lift (93 patients; years 2002 to 2005) was conducted. Using a three-incision approach for both procedures (one midline and two temporal), endoscopic visualization was used to assist in the last 2 cm of subperiosteal dissection over the superior orbital rim only in the endoscopic technique. In the nonendoscopic technique, this final dissection was performed without the endoscope, and the expected path of the supraorbital and supratrochlear neurovascular bundles through preoperative marking of their meridians was respected. Effective brow elevation, operative times, size of incisions, complications, and overall patient satisfaction were compared between groups. The authors found no significant difference in average brow elevation between the two brow lift groups (4 mm). However, the nonendoscopic brow lift was completed, on average, 20 minutes faster than the endoscopic brow lift (30 minutes versus 50 minutes) and required a smaller incision than the endoscopic brow lift (2 cm versus 2.5 cm). No nonendoscopic patient experienced permanent complications, but one endoscopic patient developed permanent paresthesias of the forehead secondary to supraorbital/supratrochlear nerve injury. Overall patient satisfaction was equivalent in both groups. The limited incision nonendoscopic brow lift is a safe and effective alternative to the endoscopic technique. With thorough anatomical knowledge of this region, it offers equivalent brow elevation, shorter operative times, smaller incisions, similarly low complications rates, and patient satisfaction and eliminates the need for costly and cumbersome endoscopic equipment.