High Hairline Research Articles

Síndrome de Sotos asociado a distonía focal

Sotos syndrome is a form of infantile gigantism characterized by excessive body size from the time of birth, particular facies, acromegalic changes and signs of non-progressive cerebral involvement. The etiology is unknown. Diagnosis is based on somatometric data and the particular phenotype traits. Biochemical and endocrine studies are normal. Torticollis is a focal dystonia and therefore more common in adults. A 20 year old woman with macrosomic features since birth presented with: weight 104 kg, height 182 cm; prognathism, hypertelorism, a broad over hanging forehead with a high hair line; large ears, hands and feet; torticollis towards the right with elevation and anteroversion of the right shoulder which caused symptomatic scoliosis. She was bradypsychic and rather slow in speech. The complementary tests done (cerebral and cervical CT and MR, bone gammography, evoked potentials, EMG-ENG, sural nerve biopsy, biopsy of skin and muscle, EEG and hormone and biochemistry studies) were normal. The torticollis was treated with botulinus toxin and improved considerably, as did the scoliosis. To date, dystonia has not been described in association with Sotos syndrome. This may be a causal association, or even perhaps hereditary, since the patient's mother had dystonia (in the form of blepharospasm).

Comparative methods for brow lift

Dr. Eaves: The first patient (Figure 1) has concerns about his high hairline and low, heavy brows, and he refuses any incisions in the scalp. Dr. Paul, would you explain your approach to treating this patient? Felmont F. Eaves III, MD Fritz E. Barton, Jr., MD David M. Knlze, MD Malcolm D. Paul, MD Rod J. Rohrich, MD Figure 1 A male patient with concerns about his high hairline and low, heavy brows. Dr. Paul: This is a patient with male pattern baldness, heavy upper lid hooding with thickened orbital orbicularis, and a very heavy fat pad, as well as a relatively low medial brow. My approach would be to elevate his brows through the upper lid. I would resect the corrugator and perform a subperiosteal forehead lift through the upper lid without any counterincisions. This would elevate his brow a few millimeters, but not as much as if the patient had thinner tissue or underwent an endo scopic brow lift. With this approach you can't accomplish the fixation as well as you could if you pulled the flap up and anchored it superiorly. Dr. Eaves: Could you give a little more detail on how you would actually fix the brow in addition to how you would control the relative elevation of the medial versus lateral portions of the brow? Dr. Paul: First I would judge how much excess upper eyelid skin is present after the brow is held at the correct level, and then perform the skin/muscle resection, taking out some of the preseptal muscle. Then I would work on the preaponeurotic fat pad. After that I would make an incision in the periosteum about 3 mm above the supraorbital rim, leaving a cuff of periosteum to sew to. I would then elevate the forehead subperiosteally all the way back to …

Midforehead Lift

Ptosis of the brow-glabellar tissues with or without vertical and horizontal wrinkling accompanies aging in other areas of the face. The direct browlift is effective in elevating and shaping brow tissues, but leaves a scar at the brow-forehead juncture and does little for glabellar deformity. The coronal forehead lift allows the correction of brow-glabellar ptosis and wrinkling with camouflage of the scar in the scalp. Male pattern hairline, thinning hair, or a high hairline may contraindicate this approach. Our technique for treating these patients is the midforehead lift. We review the anatomical considerations, patient selection, and surgical technique, showing representative cases.