Lateral Brow Ptosis Research Articles

Comparison of the effectiveness and safety of the “endoscope-assisted polypropylene mesh lift” and “gliding brow lift” techniques for the treatment of lateral brow ptosis

There are many techniques used to treat lateral brow ptosis. This study compared two techniques that are used for lateral brow rejuvenation in terms of effectiveness and safety-namely, endoscope-assisted polypropylene mesh lift (EAML) and gliding brow lift (GBL). Eighty-six patients who underwent brow lift surgery between March 2018 and June 2020 were included in this retrospective study. Forty-four patients were operated on using the EAML technique, whereas 42 patients were operated on using the GBL technique. The measurement of defined distances in photographs was carried out using a software, and the Brow Positioning Grading Scale (BPGS) and Global Aesthetic Improvement Scale (GAIS) were applied in the pre and postoperative periods. The measurement results obtained in the postoperative period were better than those obtained in the preoperative period for both the techniques, whereas the results obtained at postoperative month 3 were found to be better than those obtained at month 12 (p<0.05). The results were similar between the measurements at postoperative months 3 and 12 for both the techniques. The loss of brow height from postoperative months 3-12 was greater in the GBL group (p<0.05). The postoperative scores on the BPGS were found to be better in both techniques than the preoperative scores (p<0.05). The GAIS score at postoperative month 12 was found to be better in the EAML group. The two groups had similar rates of complications. The two techniques were found to have similar effectiveness and safety profiles for brow rejuvenation.

Lateral Temporal Subcutaneous Brow Lift: Clinical Experience and Systematic Review of the Literature.

Numerous techniques have been described to correct brow aesthetics in facial rejuvenation. We report the senior author's (A.M.) current approach for eyebrow elevation utilizing a lateral subcutaneous brow lift and, when indicated, a medial subgaleal brow lift. Furthermore, a systematic review of the literature was performed comparing the different surgical approaches and techniques. A systematic review of the literature was performed using the MEDLINE, PubMed, and Cochrane Central Register of Controlled Trials databases. Studies were included if the content was original, provided outcome data, and complications. The senior author (A.M.) has performed over 500 lateral temporal subcutaneous brow lifts for lateral brow ptosis. The vast majority was highly satisfied with the outcome and there were minimal complications. This represents the largest series of patients utilizing this technique. Twenty-six articles were reviewed and 5 met our screening criteria and were analyzed critically for inclusion and further objective review. All of the studies were retrospective in nature and report high patient satisfaction with an acceptable risk profile. In this study, we described the largest series of patients undergoing lateral subcutaneous brow lifts (n > 500), as well as a systematic review of the current literature. The current literature described an overall high degree of patient satisfaction with low complication rates, similar to the senior author's (A.M.) experience. This technique has emerged as a reliable technique for lateral brow elevation with a very low and acceptable risk profile.

Brow Ptosis: Is Transblepharoplasty Internal Browpexy Suitable for Everyone?

Transcutaneous internal browpexy can provide patients with mild-to-moderate lateral brow ptosis, stabilization and modest lift of the lateral brow. Questions regarding effectiveness of this procedure and appropriate indications remain. The authors measured consecutive patients who underwent upper eyelid blepharoplasty with transblepharoplasty internal browpexy (TIB) September 2014 to December 2017. Pre- and postoperative brow elevation was assessed based on before and after photographs of each patient. Patient photographs were assessed for medial and lateral brow elevation, brow contouring and asymmetry. Optimal lateral brow elevation was classified as bilateral symmetrical and above the supraorbital rim for women, and symmetrical and at the supraorbital rim for men. A total of 239 patients underwent bilateral TIB and 39 underwent unilateral TIB (517 eyelids in total). Pre- and post-operative measurements were taken in 98 patients (41%), with an average elevation of the lateral brow position of 2.54 mm.Six patients had an underlying infection in the first postoperative week that resolved completely. Three patients underwent a second stage direct brow lift repair and 3 needed unrecognized ptosis repair as a second stage. Transblepharoplasty internal browpexy is an important tool that can be used in most patients with lateral and central brow ptosis, asymmetric brow ptosis and irregular contour of the brow. Additionally, browpexy adds to the success and longevity of upper blepharoplasty, while preventing early recurrence of lateral upper eyelid hooding. Patients with significant ptosis, heavy brows, medial greater than lateral ptosis, and post-facial palsy may not be good candidates for this procedure.

What Neurotoxins Have Taught Us About the Brow: The Reintroduction and Review of the Transpalpebral Browpexy.

The use of neuromodulators has grown substantially in our society, particularly in the temporary treatment of brow ptosis. This study revisits the use of the transpalpebral browpexy for upper face and brow rejuvenation in the context of what has been learned from neuromodulators. A retrospective review of 97 subjects was conducted who had transpalpebral browpexy performed for lateral brow ptosis. Qualitative degree of brow elevation after the procedure was determined by examining before and after photographs for each patient. Out of 97 patients, 95 (98%) experienced aesthetically optimal brow elevation for their respective gender. Two patients required surgical revision, both of which experienced extenuating circumstances. Two patients experienced edema and one patient experienced periodic eruptions of chalazia along the upper eyelid. Transpalpebral browpexy is a reliable, minimally invasive surgical procedure that effectively emulates the results of neuromodulator injections for a much longer period of time. While it cannot replace traditional brow-lifting techniques, transpalpebral browpexy does have solid indications with proven long-lasting results, which can be effective in a significant portion of patients with brow ptosis. 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 .

Lateral Browlift Using Temporal (Pretrichial) Subcutaneous Approach Under Local Anesthesia

Lateral brow ptosis is a common aging phenomenon, contributing to the lateral upper eyelid hooding, in addition to dermatochalasis. Lateral brow lift complements upper blepharoplasty in achieving a youthful periorbital appearance. In this study, the author reports his experience in utilizing a temporal (pretrichial) subcutaneous lateral brow lift technique under local anesthesia. A retrospective analysis of all patients undergoing the proposed technique by one surgeon from 2009 to 2016 was conducted. Additional procedures were recorded. Preoperative and postoperative photographs at the longest follow-up visit were used for analysis. Operation was performed under local anesthesia. The surgical technique included a temporal (pretrichial) incision with subcutaneous dissection toward the lateral brow, with superolateral lift and closure. Total of 45 patients (44 females, 1 male; mean age: 58 years) underwent the temporal (pretrichial) subcutaneous lateral brow lift technique under local anesthesia in office setting. The procedure was unilateral in 4 cases. Additional procedures included upper blepharoplasty (38), ptosis surgery (16), and lower blepharoplasty (24). Average follow-up time was 1 year (range, 6 months to 5 years). All patients were satisfied with the eyebrow contour and scar appearance. One patient required additional brow lift on one side for asymmetry. There were no cases of frontal nerve paralysis. In conclusion, the temporal (pretrichial) subcutaneous approach is an effective, safe technique for lateral brow lift/contouring, which can be performed under local anesthesia. It is ideal for women. Additional advantages include ease of operation, cost, and shortening the hairline (if necessary).

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.

Direct brow lift combined with suspension of the orbicularis oculi muscle.

BackgroundAlthough the conventional direct brow lift operation provides a simple means of managing lateral brow ptosis, the scars produced have been unacceptable. However, using the modifications proposed here, scarring showed remarkable improvement. This article reviews our experiences with the presented technique, mainly with respect to postoperative scarring.MethodsMeasured amounts of supra-eyebrow skin and subcutaneous fat were excised en bloc in the conventional manner under 'hyper-hydrated' local infiltration anesthesia. The lower flap and the edge of the upper flap were undermined above the muscular plane, and the orbicularis oculi muscle was directly suture-plicated and suspended upward to the distal frontalis muscle. Skin closure was performed in a basic plastic surgical manner.ResultsFrom April 2007 to April 2012, a consecutive series of 60 patients underwent surgery using the above method. The average width of the excised skin was 8 mm (range, 5-15 mm) at the apex of the eyebrow. Preoperative complaints were resolved without occurrence of significant complications. The surgical scars showed remarkable improvement and were negligible in the majority of the cases.ConclusionsThe direct brow lift operation combined with plication/suspension of the superior and lateral portion of the orbicularis oculi muscle provides a simple, safe, and predictable means of correcting lateral brow ptosis. The scars were acceptable to all of the patients. For proper management of the frontalis tone, upper blepharoplasty and/or repair of eyelid levator function must be considered in addition to brow lift procedures.

Biplanar Temple Lift for Lateral Brow Ptosis: Comparison with Uniplanar Dissection Technique

Biplanar Temple Lift for Lateral Brow Ptosis: Comparison with Uniplanar Dissection Technique

Brow Suspension Suture Procedure

Introduction: This article describes a safe, effective, straightforward brow-suspension lifting technique that minimizes surgical time and can be performed under local anesthesia with predictable outcomes. Mersilene suture and a Keith needle were used to lift the medial and/or lateral brow, producing excellent surgical results. Materials and Methods: A retrospective study of 9 patients with medial or lateral brow ptosis were included in the study based on the following criteria: men with a brow height below the superior orbital rim either medially, laterally, or both; women with a brow position at or lower than the superior orbital rim medially, laterally, or both. The details of the procedure are presented. Results: All 9 patients who had the brow-suspension suture procedure reported a satisfactory result: normal brow level was restored for both men and women. Patients experienced no pain during the procedure, which was done under local anesthesia, and all were able to return to daily activities the next day. All patients indicated that if they had to undergo a brow lift again, they would prefer to have this procedure instead of the more conventional brow-lifting procedures. All of the procedures, including those that involved both medial and lateral brows, were performed under 30 minutes. Conclusions: The brow-suspension suture procedure is a safe, straightforward, minimally invasive alternative to conventional brow-lifting surgeries. It is time and cost efficient and produces effective outcomes.

Gull Wing Midforehead Lift

In case of both medial and lateral brow ptosis in a balding candidate with a furrowed forehead, one may consider a midforehead lift, a technique that has not gained much popularity because of concerns regarding clearly visible scarring. We have applied this technique in a selected group of patients and wish to share our experience discussed among a review of the English-language literature. Our series of 10 male patients (average age, 56.9; operated in period between 2003 and 2006) were contacted, asked to return for a follow-up, and interviewed; all data were collected, including the excised amount of tissue and postoperative complications. Patient satisfaction was assessed (Likert scale) as well as the objective aesthetic result using the Strasser scoring system. Eyebrow position increased significantly (P < 0.035) after surgery, and remained stable over the follow-up period of 3 years. Postoperatively, the majority of the patients (7 of 10) was satisfied with the result and would repeat surgery based on their experience (average visual analog scale score, 7; range, 4-8). In all cases, functional complaints had decreased significantly. Although most patients reported to be somewhat bothered with the initial aesthetical aspect of the scar, only 1 of 10 patients was not satisfied with the overall aesthetic result. Four patients were graded as good, 3 patients as mediocre, and 1 patient as poor as based upon the Strasser grading system. These results demonstrate that there is a limited but definite indication for the gull wing midforehead lift in cases of generalized ptosis of the forehead in balding males with high and furrowed foreheads.

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.

Morphological Changes of the Eyelid According to Age

Purpose: The morphological changes of the eyelids according to gender among different age groups in Korea were analyzed. Methods: Six-hundred adults without any ocular disease were selected, and sorted by age (ranging from 20 to 79 years), and gender. Each group consisted of 50 adults. Interpalpebral fissure (IPF), marginal reflex distance 1 (MRD1), amount of the upper lid, degree of browptosis, lateral hood width of the eyelid, and protrusion of the eyelid fat were measured. The measured values were analyzed to determine changes related to the aging process. Other age groups were analyzed and compared with the subjects between 20 and 30 years old, using the Student’s t-test with SPSS. Results: MRD 1 and IPF slightly decreased with age, but there was no statistical significance. The upper lid amount showed a statistically significant increase at the 7th and 8th decade. The degree of browptosis showed a statistically significant increase from the 7th decade of age in men, and from the 6th decade in women. In particular, the lateral browptosis was more drooped than the center browptosis. The lateral hood width of the eyelid showed a statistically significant increase from the 7th decade of age in men, and from the 6th decade in women. Eyelid fat was most protruded at the central lower part, but there was no statistical significance. Conclusions: It is important to understand the change related to aging in the study of eyelid morphology and eyelid operation. The results from present study may be used to determine standard for the safe amount of skin resection in Korean eyelid operations.

Biplanar Temple Lift for Lateral Brow Ptosis: Comparison with Uniplanar Dissection Technique

The amount of lift achievable in the temple region has been limited by traditional uniplanar dissection techniques. A biplanar temple-lifting technique (BTL), involving a biplanar dissection both deep and superficial to the superficial musculoaponeurotic system (SMAS) of the temporal region, is described. This study compares the amount of temporal lifting that can be achieved using a uniplanar dissection with that achieved using a biplanar dissection. Thirty-seven patients underwent bilateral temple lifting. Deep dissection was performed on the surface of the deep temporalis fascia. The skin flap was pulled in a superolateral direction and the skin overlap at the wound edge was measured. A SMAS flap was then dissected beneath the dermis from the anterior wound edge to the temporal hairline. The SMAS flap was suspended superolaterally and fixated to the deep temporalis fascia. The skin flap was again pulled in a superolateral direction and the amount of skin overlap was measured and compared. The average potential temple skin that could be excised using the traditional dissection technique was 15.1 mm (range, 7-24 mm). The average temple skin that was excised using the biplanar dissection technique was 21.8 mm (range, 14-30 mm). The biplanar technique was shown to offer, on average, a 48% increase in lift relative to the skin-only approach. There were no cases of wound dehiscence, necrosis, or overcorrection. Using the BTL technique to create a temporal SMAS flap, dissected free from overlying dermis as well as from deep temporal fascia, provides a more secure suspension of the temporal flap and significantly greater temple lift than a uniplanar dissection. The deep layering absorbs the tension of the lift, allowing for tensionless skin closure, thus decreasing the potential for scarring, hair loss, and necrosis. The increased mobility and higher suspension of the temporal flap allows for more skin excision and therefore a more pleasing lateral brow height.

Transpalpebral browpexy.

Transpalpebral browpexy could be performed as an adjuvant procedure to the upper blepharoplasty or as a separate procedure. It is done by separating interdigitalizing connections between the orbicularis and frontalis muscles, moving the orbicular part of the orbicularis muscle with overlying brow to the more cephalad position and again uniting both of these muscles with nonresorbable sutures in a new higher position. During the years 1990 to 1999, 55 patients (47 women and eight men) were operated on with this technique, which was partially developed by the author. Additional time required to achieve transpalpebral brow stabilization during standard blepharoplasty was approximately 30 minutes. Forty-three patients were followed, 38 of them for longer than 4 years. The elevation effect gradually decreased but persisted, with wide variations, between 1.5 and 7 more years. At the last follow-up examination, 36 of 43 patients had maintained lateral brows in the same position as before operation and sometimes even higher, which was appreciated by the patients. Complications were very few and they were correctable. Transpalpebral browpexy proved to be a useful addition to blepharoplasty and can be used for the minor adjustments after an open coronal or endoscopic brow lift. Particular indications included patients with lateral brow ptosis and discrete forehead wrinkles and balding men.

Correction of lateral brow ptosis: a nonendoscopic subgaleal approach.

The authors present their experience with a relatively uncomplicated, rapid technique for elevation of the lateral eyebrow and a simultaneous correction of eyelid hooding that is secondary to the descent of the eyebrow. The procedure is designed for all patients requiring lateral brow elevation, either separately or in combination with other procedures. The authors describe and illustrate their technique.

Lateral subcutaneous brow lift and interbrow muscle resection: clinical experience and anatomic studies.

The authors report consistent improvement in 65 patients with lateral brow ptosis by using a lateral subcutaneous brow lift at the temporal hairline. In 48 of these patients, vertical glabellar wrinkles were improved by the direct excision of procerus, corrugator, and orbicularis muscles through 3-mm medial brow incisions. Anatomic dissections in 10 cadavers and examinations of 50 skulls were used to study the location of the supraorbital and supratrochlear nerves. Dissections revealed that the supratrochlear nerve was never closer than 1.6 cm to the midline at the level of the supraorbital ridge. In no dissection was a supratrochlear foramen noted. Lateral subcutaneous brow lift was consistently successful in elevating the lateral brow. In no patient was nerve damage to the supraorbital nerve noted. In most patients, the temporal hairline was improved by excising a triangle of balding scalp. Through 3-mm medial brow incisions, the interbrow musculature can be excised by using a small rongeur in an area 3.2 cm wide without risk of nerve damage, improving vertical glabellar wrinkles.

Discontinuous coronal brow lift

Lawrence B. Robbins, MD, Miami Beach, FL, is a board-certified plastic surgeon and is president of ASAPS. The upper third of the face contributes significantly to facial appearance and expression. With aging, brow malposition and contour changes can create a tired, sad, or even an angry look.1 Brow ptosis often contributes to redundant upper eyelid skin, leading to a misdiagnosis of dermatochalasia. Raising the eyebrow, particularly laterally, may at times obviate the need to perform upper blepharoplasty or to extend a blepharoplasty incision lateral to the orbital rim. Elevation of the brow and reestablishment of an aesthetic brow contour can give the patient a younger-looking forehead and periorbital appearance. Reduction of the transverse forehead, glabellar, and lateral orbital wrinkles adds to this result. Despite the introduction of endoscopie techniques, the open brow lift is a valuable and time-tested procedure. In my experience, brow ptosis is the earliest sign of aging in the upper third of the face, which led me to modify the standard coronal and temporal techniques when treatment of lateral brow ptosis was the primary objective. Instead of one continuous coronal incision, two separate incisions are made. These discontinuous incisions come to within approximately 4 cm of the midline and allow full mobilization of the forehead flap, as well as complete release and repositioning of the eyebrow areas. This discontinuous coronal approach is indicated primarily for patients with lateral brow ptosis and avoids overelevation of the medial portion of the brow. This approach allows …

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.