Lateral Brow Research Articles

Quantification of the Aesthetically Desirable Female Midface Position

The purpose of this study was to attempt to determine a reliable method of evaluating midface position. We assessed a novel parameter called WIZDOM (Width of the Interzygomatic Distance of the Midface) and its relationship to other facial metrics. The goal was to evaluate midfacial position quantitatively in women by examining 2-dimensional photographs of a subset of women with idealized facial proportions. Three examiners analyzed stock photographs of nonsmiling female model faces. Numerous parameters were analyzed for each photograph, including: interpupillary distance, medial canthus (MC) to lip, brow length, WIZDOM, WIZDOM to MC, WIZDOM to hairline, WIZDOM to chin vertical, and lateral brow to WIZDOM. Meaningful relationships between various parameters were statistically analyzed. Examiner measurements were assessed for interobserver reliability. Fifty-five female model photographs were included in the analysis. The average interpupillary distance was 59.2 mm ± 3.54 (range, 50.5-67.3 mm). The WIZDOM average was 108 mm ± 5.81 (range, 93-127 mm) and brow length was 107 mm ± 5.87 (range, 96.7-124 mm). The difference between brow length and WIZDOM was not statistically different (P = 0.834). The interobserver reliability between the 3 examiners was excellent for all parameters (P < 0.01), ranging from 0.718 (WIZDOM-MC) to 0.993 (interpupillary distance). The WIZDOM measurement was reproducible with an interobserver coefficient of 0.939. WIZDOM can be used to quantify aesthetically desirable midfacial position in patients and can be used as a measurement to aid in assessment and as an ideal to achieve balanced aesthetic results in midface restorative procedures-lifting or volumization-in females.

Safety and Effectiveness of a Small Incision Lateral Eyebrow Ptosis Repair Technique Using a Frontalis Muscle Transposition Flap.

To evaluate the safety and effectiveness of a frontalis muscle transposition flap for treatment of lateral eyebrow ptosis. The charts of all patients undergoing frontalis muscle transposition flap eyebrow ptosis repair from December 2013 to September 2014 were reviewed. Charts with inadequate photographs were excluded. Charts were reviewed for demographics, preoperative and postoperative photographs, surgical technique, and complications. The following parameters were assessed on preoperative and postoperative photographs: corneal diameter, central brow height, and lateral brow height. Measurements were normalized to a standard corneal diameter of 11.5 mm. Statistical analysis was performed in conjunction with the Cleveland Health Institute Biostatistics Department. Forty-six total patients underwent frontalis muscle transposition flap eyebrow ptosis repair and the charts of 31 patients (53 cases) were reviewed. There were 20 female and 11 male patients. Average age was 69.1 ± 7.7 years (range: 50 - 86 years). There were 9 unilateral and 22 bilateral cases. Concomitant surgeries included upper blepharoplasty (33 cases), conjunctival-Mullerectomy blepharoptosis repair (3 cases), and intralesional tetracycline injection for festoons (3 cases). Average follow-up interval between surgery and the final postoperative photograph was 10.2 weeks (range: 6-26 weeks). Overall, lateral brow height increased postoperatively by 1.78 mm (p < 0.05). In patients that underwent frontalis muscle transposition flap alone, lateral brow height increased by 2.86 mm (p < 0.05). Scalp hypesthesia was documented in 10/31 patients, and resolved in 8/10 patients at last follow up. A frontalis muscle transposition flap effectively addresses lateral eyebrow ptosis repair through a small, relatively concealed incision. It produces temporary scalp hypesthesia in a significant number of patients, and long-term results remain unknown.

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).

ISOLATED ZYGOMATIC BONE FRACTURE

Introduction: Facial bones injuries results in functional disturbances. Patientsmay presents with flattening of normal malar prominence, lid drop, eye movement limited orwith double vision, numbness of cheek area and unilateral epitasis. Emphasizing upon incisiontype, fixation method and occasionally reconstruction, surgeons suggest different methods forrepairing complex fractures of Zygoma. Study Design: Descriptive study. Setting: Departmentof Oral &amp; Maxillofacial Surgery, Liaquat University of Medical &amp; Health Sciences, Jamshoro.Period: Mar 2013 to Feb 2014. Materials and methods: Total 20 patients were included.Patients with fracture more than 28 days old were excluded. Zygomatic bone can be approachedby lateral brow or subcilicary incisions and by subgingival buccal sulcus approach. When 3fracture sites were reduced and aligned satisfactorily, application of miniplates was performedat 3 points frontozygomatic suture, Zygomatico maxillary buttress and infraorbital rim, woundwere closed in 2 layers. At 2nd week follow-up patients were assessed for outcome. Results:There were 14 male and 6 female patients. Most were of age &lt;25 years. 45% fractures weredue to RTA. Duration of fracture of 2 patients was 2 days, 7 days of 11 patients, 4 patients had14 days and 3 patients had 28 days. 5 fractures were reduced using Gilies temporal approach,6 with Keen approach, 4 with Hook approach and 5 with Dingman approach. Preoperatively,17 patients had facial asymmetry, 19 had limited mouth opening and postoperatively this wasreduced to 6 cases each for facial asymmetry and limited mouth opening. Conclusion: Itis concluded from this study that three point fixation is most effective and safe method forreduction of fracture of Zygomatic bone.

English

Introduction: Facial bones injuries results in functional disturbances. Patientsmay presents with flattening of normal malar prominence, lid drop, eye movement limited orwith double vision, numbness of cheek area and unilateral epitasis. Emphasizing upon incisiontype, fixation method and occasionally reconstruction, surgeons suggest different methods forrepairing complex fractures of Zygoma. Study Design: Descriptive study. Setting: Departmentof Oral &amp; Maxillofacial Surgery, Liaquat University of Medical &amp; Health Sciences, Jamshoro.Period: Mar 2013 to Feb 2014. Materials and methods: Total 20 patients were included.Patients with fracture more than 28 days old were excluded. Zygomatic bone can be approachedby lateral brow or subcilicary incisions and by subgingival buccal sulcus approach. When 3fracture sites were reduced and aligned satisfactorily, application of miniplates was performedat 3 points frontozygomatic suture, Zygomatico maxillary buttress and infraorbital rim, woundwere closed in 2 layers. At 2nd week follow-up patients were assessed for outcome. Results:There were 14 male and 6 female patients. Most were of age &lt;25 years. 45% fractures weredue to RTA. Duration of fracture of 2 patients was 2 days, 7 days of 11 patients, 4 patients had14 days and 3 patients had 28 days. 5 fractures were reduced using Gilies temporal approach,6 with Keen approach, 4 with Hook approach and 5 with Dingman approach. Preoperatively,17 patients had facial asymmetry, 19 had limited mouth opening and postoperatively this wasreduced to 6 cases each for facial asymmetry and limited mouth opening. Conclusion: Itis concluded from this study that three point fixation is most effective and safe method forreduction of fracture of Zygomatic bone.

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.

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.

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 …

Combined resection of preseptal fat and partial retro-orbicularis oculus fat: a method for refractory upper eyelid heaviness correction

OBJECTIVE To investigate an operative method of combined resection of preseptal fat: and partial retro-orbicularis oculus fat (ROOF) for correction of upper eyelid heaviness, and evaluate the efficacy and safety of the method. Preseptal fat lies widely under the orbicularis oculi in the upper eyelid, and retro-orbicularis oculus fat (ROOF) lies in the lateral supraorbital area. Combined resection of preseptal fat and partial ROOF was performed in patients selected by examination. The efficacy and safety were evaluated by follow-up study. From May 2011 to July 2013, 38 selected patients received the treatment with 3 months to 28 months follow up. The heaviness of upper eyelid improved in all cases. One patient developed postoperative hematoma, and another patient had a transient numbness over the lateral upper brow region. 37 patients were satisfied with the result. Combined resection of preseptal fat and partial ROOF was effective in reducing the heaviness of upper eyelid, without major complications. The operative method should be an important adjunct for selected patients undergoing blepharoplasty.

Correction of Metopic Synostosis Utilizing an In Situ Bandeau Approach

Metopic craniosynostosis is a common growth disturbance in the infant cranium, second only to sagittal synostosis. Presenting symptoms are usually of a clinical nature and are defined by an angular forehead, retruded lateral brow, bitemporal narrowing, and a broad-based occiput. These changes create the pathognomonic trigonocephalic cranial shape. Aesthetic in nature, these morphological changes do not constitute the only developmental issues faced by children who present with this malady. Recent studies and anecdotal evidence have also demonstrated that children who present with metopic synostosis may face issues with respect to intellectual and/or psychological development. The authors present an elegant approach to the surgical reconstruction of the trigonocephalic cranium using an in situ bandeau approach.

The lateral brow: position in relation to age, gender, and ethnicity.

Despite multiple studies regarding modes of eyebrow measurement and movement over time, the lateral aspect of the brow has been relatively ignored in the literature. Therefore, we arranged a study of the most lateral aspect of the eyebrow; in doing so, we hoped to ascertain the most practical line or angle of measurement. In this cross-sectional study, adults age 18 years and older with no history of congenital or acquired periorbital or orbital pathology or surgery, brow tattooing or heavy plucking, phthisis, or strabismus were measured using a combination of in-office metrics and computer analysis. Subjects were asked to identify their ethnicity and country of origin. Models of age, gender, and ethnicity were created. One thousand twenty-four subjects were included (1,944 eyes). Measurements of nasal ala to lateral brow (NALB), lateral brow plumb line (LBPL; the vertical line between the tail of the brow and a horizontal line extending from the lateral canthus), and angle from the midbrow to the lateral brow tail showed statistically significant decline over time. The angle and LBPL varied mostly by ethnicity. The angle narrowed approximately 3° per 20 years, while the LBPL fell approximately 2.5 mm per 20 years. The NALB varied most by age and fell approximately 3 mm per 20 years. The lateral tail of the brow descends with age. Measurements of its location and rate of change vary between genders and within ethnic groups. Two easily measured values-NALB and LBPL-can be used for preoperative planning and postoperative documentation.

Infraeyebrow Blepharoplasty Incorporated Browpexy in an Asian Population

In Taiwan, upper blepharoplasty has become one of the most commonly performed rejuvenation operations. Many surgeons have modified their approaches to managing the aging changes of the upper eyelids. We elucidate our experiences of applying infraeyebrow blepharoplasty incorporated with browpexy and periosteum scoring, including its indications, operative procedures, and postoperative changes after the surgery in our research. Eighty lids in 40 patients were subjected to this surgery from January 2010 to January 2012. All patients had upper eyelid dermatochalasis with visual field limitation, and the functions of their levator palpabrae were all normal. The primary indications of the procedure were upper lid dermatochalasis with lateral hooding. These 40 patients underwent infraeyebrow blepharoplasty incorporated with browpexy at Taipei Veteran General Hospital. The average patient age was 59.5 years (36-73 years). The average resection width was 12.3 mm (8-15 mm). The mean operative time was 50 minutes. The mean height of brow descending at the midpupil line was 2.4 mm (0-4 mm). The mean height of lateral brow descending was 2.74 mm (-0.6 to 5.4 mm). The lateral brow was higher than the middle brow with a mean height of 2.64 mm (0-4.2 mm). All patients were satisfied with the results. No complication related to sensory abnormalities and visible scars was observed. Our modified method with infraeyebrow blepharoplasty incorporated with browpexy not only keeps the advantages, which have been mentioned in previous literature, but also keeps the lateral brow in an ideal position and avoids the flattening of the brow.

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.

The Quantitative Effect of Botulinum Toxin A Over Brow Height

Botulinum toxin type A (BTX-A) is currently used in temporal brow lifting. Reducing the activity of the superolateral portion of orbicularis oculi muscle causes lateral brow elevation. The objective of this study was to determine the quantitative brow elevation after paralysis of the superolateral portion of orbicularis oculi muscle. This study includes 10 female patients. Six units of BTX-A were injected into the superolateral portion of the orbicularis oculi in a serial manner into 3 points, below the lateral half of the brow at each side. Bilateral measurements were obtained by using calipers, immediately before and 2 weeks after the treatment. The medial canthus to the medial brow margin (AB), the lateral brow margin to the lateral canthus (CD), the medial brow margin to the lateral brow margin (BC), the brow apex to upper lid margin at the level of the lateral limbus (EF), the brow apex to the medial brow margin (EB), the brow apex to the lateral brow margin (EC), and upper eyelid margin to lower eyelid margin at the level of the pupil (GH), were measured. There were no statistically significant differences found between pretreatment and posttreatment left and right measurements. There were statistically significant increases in CD, EF, and GH measurements, which are point out brow elevation. There were no statistically significant differences found in other measurements. Same doses of BTX-A application did not disrupt symmetry. Applications of 6U BTX-A to the superolateral portion of orbicularis oculi provide brow elevation and increased interpalbebral distance and upper eyelid distance. Our study has confirmed that BTX-A treatment of superolateral portion of the orbicularis oculi muscle produces quantitative temporal brow elevation.

Facial Rejuvenation With Fine-Barbed Threads: The Simple Miz Lift

Since the invention of the first barbed (short) suture by Sulamanidze in the late 1990s, different techniques have been described including Woffles (long) thread lifting, Waptos suture lifting, Isse unidirectional barbed-threads lifting, and silhouette lifting. The authors have implemented a newly developed type of thread integrating more small cogs and a soft and fragile feeling of the material (medical grade polypropylene: 16.5cm long, 15cm of length covered with cogs, and 0.40mm in diameter). This study aimed to describe the authors' thread and the surgical techniques they have adopted to counteract the descent and laxity of facial soft tissues. A retrospective chart review was performed during a period of 2years, from March 2010 to February 2012. The procedure was performed with the patient under local anesthesia and intravenous sedation. The face was marked preoperatively to determine the appropriate vector of the thread and its five end fixation points. The superior border of the incision was approximately at the level of the lateral brow, and the lower border was about 2cm above the superior margin of the helical root. After the temporal incision was made, the dissection was carried all the way down to the deep temporal fascia to create a plane between the superficial and deep temporal fascias. Using blunt cannulas, the dissection was continued in an inferomedial direction from the temporal incision to the lower face through the sub-submucosal aponeurotic system (sub-SMAS) plane, which was marked preoperatively. This sub-SMAS dissection could easily proceed to the premasseteric space (PMS). The face-lift sutures (Gusan Inc., Seoul, Republic of Korea) then were inserted through the cannula from the lower face to the temporal incision line. The sutures were trimmed, and the proximal ends were secured on the deep temporal fascia reinforced with Vicryl interrupted sutures. The results were assessed objectively using serial photography and subjectively according to patient assessment. Complications also were recorded. All but two patients (100/102, 98.1%) were satisfied with the outcomes after surgery. Consensus ratings by two independent plastic surgeons found that objective outcomes were divided among "excellent," "good," and "fair." The postoperative course was uneventful except for one patient (1/102, 1%) who presented with minor skin dimpling and another patient (1/102, 1%) who had a temporary facial weakness. These two complicated cases were resolved spontaneously without any surgical interventions. The reported technique has several advantages over current approaches. First, the use of nonabsorbable sutures with sufficient maintenance potential can produce long-lasting, satisfying results. Second, use of the authors' fine thread can avoid complications such as extruded or visible thread, which often have been complaints with thread lifting. Third, use of a loose areolar plane, including sub-SMAS and PMS free of vital structures, which is deeper than the traditional lift procedure, can avoid any traction line during rest or animation without any significant complications. 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 .

Inner Table Corticectomy of the Fronto-Orbital Bar in Correction of Metopic and Coronal Craniosynostoses

Fronto-orbital advancement is an established method for correction of metopic and coronal craniosynostoses. Many techniques involve creation of a single fronto-orbital bar that is then shaped with osteotomies with or without bone grafting. We present a technique that minimizes osteotomy of the frontal bar and gives superior lateral brow aesthetics.Standard fronto-orbital bar bone cuts are made without a midline osteotomy. Selective inner table corticectomy of the fronto-orbital bar allows the bone to become malleable without greensticking. The need for osteotomy of the fronto-orbital bar is obviated. An additional bandeau is created from the temporoparietal calvaria. The malleable fronto-orbital bar is then fixed to this bandeau. The frontal bar and bandeau complex is then advanced in a conventional manner. The remaining frontal calvaria is then rotated creating a more vertical forehead.This technique has been used in Leeds for more than 10 years with good cosmetic results. It has become our standard method for management of the fronto-orbital bar in correction of nonsyndromic metopic and coronal craniosynostoses.

Correction of Enophthalmos With Rib Bone Segment and Diced Cartilage Grafts

We introduce our experiences of correcting enophthalmos with a rib bone segment graft and diced cartilage graft simultaneously.The affected orbit was exposed through a subcilliary incision, a medial brow incision, and a lateral brow incision. The periorbita was carefully dissected from the bony orbit circumferentially. The affected area was examined, and the size and shape of the bone graft were determined. A 5-cm incision was made at the 7th rib-cartilage junction, and the 7th and 8th ribs and costal cartilage was harvested as needed. The donor site was closed. The harvested rib bone segment was molded with a bender to fit the defect, and the cartilage was diced into 2 × 2 × 2-mm cubes. The diced cartilage was inserted into the subperiosteal space, and fibrin glue was sprayed.Nine patients (3 male and 6 female subjects) were operated on, and the average follow-up period was 9 months. On the exophthalmometry, the preoperative difference was 4.6 ± 1.7 mm, and this improved to 1.4 ± 0.8 mm at 3 months postoperatively. The average improvement was 3.2 mm.It is thought that the correction of enophthalmos by the combined use of a rib bone segment and cartilage grafts is very effective because bone and cartilage have complimentary effects in maintaining the globe's position.

Reduction of Zygomatic Fractures Using the Carroll-Girard T-bar Screw

Zygomatic fractures are the second most common facial bone fractures encountered and treated by plastic surgeons. Stable fixation of fractured fragments after adequate exposure is critical for ensuring three-dimensional anatomic reduction. Between January 2008 and December 2010, 17 patients with zygomatic fractures were admitted to our hospital; there were 15 male and 2 female patients. The average age of the patients was 41 years (range, 19 to 75 years). We exposed the inferior orbital rim and zygomatic complex through a lateral brow, intraoral, and subciliary incisions, which allowed for visualization of the bone, and then the fractured parts were corrected using the Carroll-Girard T-bar screw. Postoperative complications such as malar asymmetry, diplopia, enophthalmos, and postoperative infection were not observed. Lower eyelid retraction and temporary ectropion occurred in 1 of the 17 patients. Functional and cosmetic results were excellent in nearly all of the cases. In this report, we describe using the Carroll-Girard T-bar screw for the reduction of zygomatic fractures. Because this instrument is easy to use and can rotate to any direction and vector, it can be used to correct displaced zygomatic bone more accurately and safely than other devices, without leaving facial scars.