Brow Lift Research Articles

Naso-Glabello-Frontal Advancement Reconstruction for Chondroid Syringoma of the Nasal Tip

OBJECTIVE: To present a naso-glabello-frontal advancement modification of the dorsal advancement (Rintala) flap for reconstruction of an unusual case of chondroid syringoma occurring at the nasal tip.
 METHODS:
 Design: Case report
 Setting: Tertiary Government Training hospital
 Patient: One
 RESULTS: A 23-year-old man who presented with a nasal tip mass initially diagnosed as a benign adnexal tumor underwent excision and reconstruction with a naso-glabello-frontal advancement flap modification of the dorsal advancement flap with median brow lift. The procedure resulted in nasal tip reconstruction with minimal scars, including a horizontal upper medial brow margin scar that eventually became less apparent. Final histopathology revealed a rare benign mixed tumor, chondroid syringoma.
 
 CONCLUSION: The naso-glabello-frontal advancement flap is a one-stage procedure that can be used to reconstruct such a cutaneous nasal defect after tumor excision. The modification observes nasal aesthetic subunits and may have a better aesthetic outcome than traditional rotational flaps or advancement flaps.
 
 Keywords: rhinoplasty, surgical flaps, sweat gland neoplasm
 

이마 및 중안면거상술

이마 및 중안면거상술

Brow reduction, reshaping and suspension by a 20-degree beveled brow incision technique.

A huge number of procedures for forehead and brow rejuvenation have been described. Nevertheless, the surgical approach of brow aesthetics in terms of correction of brow fullness and symmetry has not been systematically evaluated in the literature. We recently proposed a 20-degree beveled brow incision technique for direct brow lifting. The aim of the present study is to evaluate the 20-degree beveled brow incision technique for brow reduction, reshaping and correction of brow symmetry. Eighteen patients underwent brow reshaping by using the 20-degree beveled brow incision technique combined or not with other lifting procedure (brow lift, blepharoplasty, face lift). The surgical outcome was evaluated by photographic documentation and a questionnaire on patient satisfaction. Follow-up was at least 6 months. The surgical outcome in terms of brow symmetry, fullness and scaring was very good in 14 of 18 patients, good in 2 patients and poor in 2 patients. The last two patients were smokers. Motor or sensibility disorders were not observed. The 20-degree beveled brow incision technique seems to be saved and effective as surgical procedure to improve brow aesthetics in terms of symmetry and fullness while a supplement lifting maneuver is easily to perform.

An aesthetic approach in the repair of anterior frontal sinus fractures

The management of upper facial trauma is a common responsibility of surgeons taking care of maxillofacial injuries. Historically, the most commonly used surgical approach has been the bi-temporal (coronal) incision. As is well known, the coronal incision carries some inherent complications such as hair loss, long scars, and increased length of hospital stay. The purpose of this article is to describe an aesthetic approach, similar to an endoscopic brow lift, for the repair of anterior wall fractures of the frontal sinus without the need for long incisions or fixation devices.

A Novel Supra-Brow Combined with Infra-Brow Lift Approach for Asian Women.

BackgroundDirect brow lift surgery remains popular among Asian women despite its disadvantages. The traditional direct brow lift by a supra-brow incision is not suitable for Asian women because of their unique facial features, such as higher eyebrows, wider upper eyelids, and more orbital fat. Therefore, we designed a novel brow lift technique via a supra-brow combined with an infra-brow approach for Asian women.MethodsAn area of skin above and below the eyebrow was measured, demarcated, and surgically removed. The redundant orbicularis oculi muscle (OOM) was excised while keeping the frontalis muscle intact. The OOM in the inferior flap was elevated and sutured to the frontalis muscle. In cases of puffy eyelids, orbital fat was partially removed through an infra-brow incision. Finally, a series of modifications were performed to reduce post-operative scarring.ResultsA total of 496 patients underwent this surgery from July 2009 to December 2013 and 432 patients were followed up for at least 6 months after surgery. Post-operative scars, in most patients (428/432), were inconspicuous. There were no facial nerve injuries documented and eight patients reported transient forehead numbness. The height of the palpebral fissure was increased but there was no marked increase observed of the distance between the upper eyelid edge and the eyebrow. In follow-up visits, 409 out of 432 patients (94.7 %) were satisfied with their surgical results.ConclusionsThis new brow lift technique via a supra-brow combined with an infra-brow approach provided a simple and safe surgical repair of lateral brow ptosis, upper eyelids hooding, and crows’ feet in Asian women. The surgical outcomes were predictable and the scars were inconspicuous.Level of Evidence IVThis 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 facial rejuvenation: the role of surgical and non-surgical interventions

The upper face occupies about one third of the surface area of the face. It is comprised of the forehead, temples, brow, glabella and upper eyelids, as well as underlying anatomical structures. With time, the upper face succumbs to photodamage, skin thinning, dynamic and static rhytides, gravitational changes, soft tissue loss and bone loss, resulting in pigmentation, crepiness, wrinkles, sagging, and a gaunt appearance. Surgical procedures, such as blepharoplasty and brow lift, and non-surgical interventions, such as neurotoxins, dermal fillers, ablative and non-ablative lasers, ultrasound therapy and advanced skin treatments, can both transform and rejuvenate the upper face. Prevention as well as correction should be discussed when working with patients of various ages and needs. Both anatomical ‘danger zones’ and potential adverse events associated with procedures for upper facial rejuvenation should be understood so that aesthetic practitioners are equipped to deliver optimal treatment outcomes.

Objective Brow Height Measurements Following Pretrichial Brow Lift and Upper Lid Blepharoplasty.

Background:As the ptotic brow drops below the supraorbital rim, it can exacerbate dermatochalasis by pushing the adjacent skin of the upper lid further down.Aim:The purpose of this study was to evaluate the outcomes associated with a combined pretrichial brow lift and upper lid blepharoplasty in patients with dermatochalasis and mild to moderate brow ptosis.Materials and Methods:A retrospective case series of 46 patients with dermatochalasis and mild to moderate brow ptosis treated with a combined, bilateral pretrichial brow lift and upper lid blepharoplasty from January 2008 to December 2011. Main outcome measures included measurements of brow lift at 3 months post-operatively, complications encountered, patient satisfaction and surgeon satisfaction.Results:Outcomes from 46 patients were evaluated. The mean brow lift was 1.85 mm at the lateral canthus, 1.54 mm at the lateral limbus, 1.31 mm at the mid-pupil, and 1.07 mm at the medial limbus. Brow lift at the lateral canthus was significantly more elevated than at the medial limbus (P < 0.001). Minor complications were encountered in seven of 46 patients (15.2%). Mean patient satisfaction score was 3.20 and surgeon satisfaction 3.24 (max = 4, very satisfied).Conclusions:The modified pretrichial brow lift offered effective lateral lift that complements an upper lid blepharoplasty. This technique was met with a high degree of patient and surgeon satisfaction, and had a minimal complication profile.

Direct brow lifting: Specific indications for a simplified approach to eyebrow ptosis.

Context:Brow lifting is an essential element in the rejuvenation of the ageing face. Various surgical techniques have been described. Among these, the direct brow lifting is an easy and effective technique that is often neglected because the scar can remain visible. Thus, this approach is usually reserved for elderly patients and males, with thick bushy brows.Aims:The authors present their result from a series of fifty consecutive patients treated over 2 years with direct brow lift. The aim is to demonstrate when the hairline is high or temporal alopecia is present and whether this technique is the best in bald patients, when some surgical steps are carefully adhered to. In these cases, the scar is less visible, hidden in the brow and is a good solution in women too.Subjects and Methods:Between January 2011 and January 2013, fifty patients underwent direct brow lift surgery. All were men. In all the cases, brow lifting was undertaken together with an upper blepharoplasty. The amount of brow elevation produced was assessed by comparing the vertical distances between the superior eyebrow hairline and the inter-pupillary line, pre- and post-operatively. The result and the scar quality were assessed both by the patient and the surgeon.Statistical Analysis Used:The paired t-test.Results:The authors obtained statistically significant results in brow elevation in 98% of the patients after a 12-month follow-up. The main complication associated with this procedure was visibility of the scar in two patients.Conclusions:The direct brow lift technique in bald men and with a high anterior hairline provides excellent and long-lasting results.

Subcutaneous lateral brow lift ("Z-lift").

Surgical eyebrow lift has been described by using many different open and endoscopic methods. Difficult techniques and only short time benefits oft lead to patients’ complaints. We present a safe and simple temporal Z-incision technique for eyebrow lift in 37 patients. Besides simplicity and safety, our technique shows long lasting aesthetic results with hidden scars and a high rate of patient satisfaction.

Comments on “Lateral Subcutaneous Brow Lift: Updated Technique”

I read the article by Mahmood and Baker,1 describing their lateral subcutaneous brow lift technique, with interest. With their technique, which uses a subcutaneous flap, the authors aim to achieve long-term restoration of the lateral eyebrow. The points and ideas the authors raise, particularly the concept of employing a subcutaneous plane in brow lift procedures, are very valuable. As the authors indicate, utilizing the technique they describe tends to result in a better outcome compared with the deeper dissection employed in endoscopic brow lifts. However, when considering Mahmood and Baker's brow lift technique, I would like to draw the reader's attention to an alternative, which could produce a more dynamic end result. Static fixation is a part of both endoscopic and subcutaneous brow lift approaches.2 In the former approach, the muscle is attached to the skull with a screw or a MiTek anchor (Chesterfield, MO), and, in the latter …

Lateral Brow Lift: A Multi-Point Suture Fixation Technique.

BackgroundDescent of the lateral aspect of the brow is one of the earliest signs of aging. The purpose of this study was to describe an open surgical technique for lateral brow lifts, with the goal of achieving reliable, predictable, and long-lasting results.MethodsAn incision was made behind and parallel to the temporal hairline, and then extended deeper through the temporoparietal fascia to the level of the deep temporal fascia. Dissection was continued anteriorly on the surface of the deep temporal fascia and subperiosteally beyond the temporal crest, to the level of the superolateral orbital rim. Fixation of the lateral brow and tightening of the orbicularis oculi muscle was achieved with the placement of sutures that secured the tissue directly to the galea aponeurotica on the lateral aspect of the incision. An additional fixation was made between the temporoparietal fascia and the deep temporal fascia, as well as between the temporoparietal fascia and the galea aponeurotica. The excess skin in the temporal area was excised and the incision was closed.ResultsA total of 519 patients were included in the study. Satisfactory lateral brow elevation was obtained in most of the patients (94.41%). The following complications were observed: total relapse (n=8), partial relapse (n=21), neurapraxia of the frontal branch of the facial nerve (n=5), and limited alopecia in the temporal incision (n=9).ConclusionsWe consider this approach to be a safe and effective procedure, with long-lasting results.

Aging Asian Upper Blepharoplasty and Brow.

The preoperative comprehensive evaluation of aging Asian patients seeking an Asian upper blepharoplasty and brow lift is imperative and should be performed meticulously. There are many methods of upper Asian face rejuvenation. Among them, the proper selection of operative technique is necessary. The operative technique for an aging Asian upper blepharoplasty and brow lift should be performed based on anatomical structures and their relationship. Modifications to the procedure are correlated with the degree of periorbital aging. The height of double fold in an aging Asian upper blepharoplasty should not exceed 10 mm from the eyelid margin when the eye is closed. The preservation of orbital fat during a blepharoplasty is needed for the prevention of periorbital hollowing, which looks older. For satisfactory results in aging Asian upper blepharoplasty and brow lift, the harmonization of the position of the upper eyelid and eyebrow is important. Noninvasive rejuvenation such as botulinum toxin and filler are good options for facial rejuvenation.

Cosmetic Microdroplet Botulinum Toxin A Forehead Lift: A New Treatment Paradigm.

To investigate the safety and efficacy of a microdroplet, cosmetic, periocular botulinum toxin A method that extensively treats the eyebrow depressors but leaves the brow elevators untreated. This is a 5-year retrospective, consecutive, nonrandomized series of botulinum toxin treatments. The study was reviewed by an institutional review board and complied with the Health Insurance Portability and Accountability Act (HIPAA). Patients were treated with 33 U onabotulinum toxin (BOTOX, Allergan, Inc., Irvine, CA, U.S.A.) injected in microdroplets of 10 to 20 μl. Sixty to 100 injections of microdroplets were needed to complete a treatment pattern concentrated at the brow, glabella, and crows feet area. The forehead was not treated. Patients who returned between 10 and 45 days were studied with image analysis. There were 563 consecutive microdroplet treatments on 227 unique patients (female, n = 175, mean age 46 ± 4 years; male, n = 52, mean age 44 ± 8 years). The incidence of ptosis was 0.2% and transient. Forty-nine patients returned for a follow-up visit between 10 and 45 days and were included for image analysis to compare the before and after results of treatment. The average brow height was 24.6 mm before and 25 mm after treatment (p = 0.02). Photonumeric scales for forehead lines, brow ptosis, and brow furrow all showed statistically significant improvements (p < 0.0001). The microdroplet brow lift method safely concentrates cosmetic botulinum toxin treatment along the eyebrow, crows feet, and glabellar area, resulting in a brow lift effect that reduces forehead lines, elevates the eyebrow, and reduces the furrow along the brow. This new treatment paradigm results in an aesthetic improvement to the face and periocular area without the forehead paralysis associated with conventional treatment.

A Simple Paradigm in Facial Rejuvenation Greatly Improves Acceptance or “The Emoticon Effect”

Introduction: Merely mimicking youth in an aging face can be elusive and controversial. Restoring the vitality, pleasantness, and fitness of the face (improving the expression). has been greatly rewarding for my patients. Holistic parameters are instilled in my approach to countering the negative societal responses to older faces. The objectives of this study were to (1) measure the social impact of focused facial rejuvenations and (2) validate the combination of original techniques used in this series. Materials and Methods: Eighty medical students were asked to rate, in term of “social acceptance/desirability,” a random mix of before-and-after photographs of 15 women, aged 45 to 75 years old, who had undergone facial rejuvenation. Results: A clear gain in social acceptance is demonstrated in after results. Conclusions: The marked increase in social acceptance after improving expression or “Emoticon effect” amply supports this simple paradigm in the planning of a facial rejuvenation. The combination of a vertical refresher lift, a modulated dual-plane brow lift (subcutaneous/subgaleal), and simultaneous sectional fat grafting has been instrumental in obtaining the desired results.

Lateral Subcutaneous Brow Lift: Updated Technique.

Age-related changes affecting the periorbital area and resulting in eyebrow ptosis have a greater impact on the lateral eyebrow; correction of this deformity is a common request from patients seeking periorbital rejuvenation.1 Various techniques have been utilized to address eyebrow ptosis, including the coronal brow lift, endoscopic technique, anterior hairline approach, transpalpebral lift, midforehead lift, and direct brow lift. Furthermore, arguments for dissection in each of the different tissue planes—subcutaneous, subgaleal, or subperiosteal—have all been discussed. Each of these approaches has specific indications, risks, and benefits, and should be selected after comprehensive evaluation of the patient.2-4 In our experience, a full coronal incision often results in an obvious midline scar in the central forehead, increases the risk of elongating the vertical height of the forehead, and can result in paresthesias posterior to the hairline, a symptom that is very bothersome to patients. Endoscopic brow lifts require additional equipment with increased operative time, and the deeper dissection involved in this technique results in suboptimal brow elevation compared to the subcutaneous approach. Furthermore, not all patients are appropriate candidates for endoscopic brow lifts, including those with significant convex frontal bones, high or receding hairlines, deep transverse rhytides, or significant brow ptosis. In patients presenting with lateral brow descent, the temporal or lateral subcutaneous brow lift has produced consistent and effective results. This technique has been well described in the literature, and has several advantages, including shorter operative time, feasibility under local anesthesia, decreased …

Eyes of beautiful women and femme fatales depicted in Western portraits.

This study aimed to compare the eyes of beautiful women and femme fatales depicted in Western portraits. A total of 37 samples were collected; 19 beautiful women and 18 femme fatales. Nine aspects were measured in reference to the corneal horizontal diameter. The estimated corneal vertical diameter was calculated by a corneal horizontal diameter multiply constant, 1.11.The double-fold was observed in 89% (17 of 19) of the beautiful women and 83% (15 of 18) of the femme fatales. The eye-width ratio was 2.42 (SD, 0.28) in the beautiful women and 2.31 (SD, 0.34) in the femme fatales. The eye-height ratio was 0.91 (SD, 0.18) in the beautiful women and 0.84 (SD, 0.10) in the femme fatales. Eyebrow-to-upper lid distance was 0.92 (SD, 0.35) in the beautiful women and 0.89 (SD, 0.23) in the femme fatales. The interpupillary distance was 5.00 (SD, 0.46) in the beautiful women and 5.00 (SD, 0.71) in the femme fatales. The intercanthal distance was 2.72 (SD, 0.42) in the beautiful women and 2.78 (SD, 0.73) in the femme fatales The outer canthal distance was 7.32 (SD, 0.64) in the beautiful women and 7.20 (SD, 1.01) in the femme fatales. The ptosis amount was -0.01 (SD, 0.18) in the beautiful women and 0.06 (SD, 0.01) in the femme fatales. For the above 7 measurements, there were no significant differences between the 2 groups (P > 0.05, t test).It is noteworthy that the beautiful women and femme fatales have the same interpupillary distance (5.00). Also, the ptosis ratio was almost zero in both groups (-0.01 [SD, 0.18] in the beautiful women and 0.06 [SD, 0.01] in the femme fatales). The results of this study might be of some reference in performing eyelid surgeries especially in brow lifts or canthoplasties.

Risk of ocular blood splatter during oculofacial plastic surgery.

To assess intraoperative blood splatter to the ocular surface and adnexa during oculofacial surgery. Four surgeons and multiple assistants at three separate locations wore a total of 331 protective eye shields during 131 surgeries. Postoperatively, a luminol blood detection system was used to identify blood splatter on the shields. In the event of positive blood splatter, the total number of blood spots was counted. Controls were used to verify the blood detection protocol. A postoperative questionnaire was given to all surgeons and assistants after each case, and they were asked whether intraoperative blood splatter was noticed. Blood was detected on 61% of eye shields and in a total of 80% of surgical cases. However, only 2% of blood splatters were recognized intraoperatively by the surgical participants. There was no significant difference in the splatter rate between surgeons (64%), assistants (60%), and surgical technicians (58%) (p = 0.69). Shields worn during full-thickness eyelid procedures, direct brow lifting, orbitotomy with bony window, and orbital fracture repairs were more likely to be splattered (p = 0.03), and there was a significant difference between splatter rates among different surgeons (range, 29-90%; p = 0.0004), suggesting that blood splatter rate may be both procedure dependent and surgeon dependent. Mucocutaneous and transconjunctival transmission of human immunodeficiency virus and viral hepatitis has been documented. These results suggest that oculofacial plastic surgeons should consider eye protection for patients with known blood-borne diseases and in cases where blood splatter is expected. This precautionary practice is supported by the high incidence (98%) of undetected, intraoperative blood splatter.

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.

2014 SICPRE Proceedings: Meeting Proceedings.

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.

Total facelift: forehead lift, midface lift, and neck lift.

Patients with thick skin mainly exhibit the aging processes of sagging, whereas patients with thin skin develop wrinkles or volume loss. Asian skin is usually thicker than that of Westerners; and thus, the sagging of skin due to aging, rather than wrinkling, is the chief problem to be addressed in Asians. Asian skin is also relatively large in area and thick, implying that the weight of tissue to be lifted is considerably heavier. These factors account for the difficulties in performing a facelift in Asians. Facelifts can be divided into forehead lift, midface lift, and lower face lift. These can be performed individually or with 2-3 procedures combined.