Open Brow Lift Research Articles

Gender-Affirming Facial Feminization Surgery at a Public, Safety-Net Hospital: A Single-Center Early Experience.

Facial feminization surgery (FFS) remains inaccessible to many transgender patients. Zuckerberg San Francisco General Hospital (ZSFG) was among the first public, safety-net hospitals to perform FFS. The purpose of this study is to examine the postoperative outcomes of patients who underwent FFS at ZSFG and describe barriers to providing FFS in a public hospital setting. A retrospective review identified patients who underwent FFS at ZSFG. Demographic data, comorbidity profiles, postoperative outcomes, and hospital utilization data were collected from the medical records. FACE-Q modules (scored 0-100) were used to survey patient satisfaction at least 1 year postoperatively. Seventeen patients underwent comprehensive FFS surgery at ZSFG. The median age was 41 years [interquartile range (IQR): 38-55], median body mass index was 26.4 (IQR: 24.1-31.3). Patients underwent a median of 9 procedures, the most common of which included frontal cranioplasty (n=13, 77%), open brow lift (n=13, 77%), rhinoplasty (n=12, 71%), and mandible contouring (n=12, 71%). There were no complications, readmissions, or reoperations within 30 days. Patients reported high satisfaction with the surgical outcome (median: 87, IQR: 87-100), excellent postoperative psychological functioning (median: 100, IQR: 88-100), and low levels of appearance-related distress (median: 3, IQR: 0-35). An estimated 243 operating room hours and 51 inpatient bed days were required to cover all FFS procedures. Performing FFS in a public, safety-net hospital was associated with zero postoperative complications, few revision procedures, and excellent patient satisfaction. Limited operating room hours and inpatient availability represented barriers to providing FFS in this setting.

Open Eyebrow Correction

The open brow lift is a powerful tool for facial rejuvenation of the upper third of the face which can address rhytids, upper eyelid hooding, and brow ptosis. With a history dating back over a hundred years, a variety of techniques have been described including coronal, pretrichial, mid-forehead, direct supraciliary, and transpalpebral brow lifts. These vary in terms of invasiveness and the ideal approach is determined by patient age, sex, symmetry, and anterior hairline characteristics. While endoscopic techniques became popular in the 1990s based on novelty, smaller incisions, less post-scar numbness, and a perception of less invasive nature, this technique’s popularity has diminished recently and less invasive open approaches have become more popular. Recent years have seen the numbers of all forms of brow lift become less common as neuromodulators, such as botulinum toxin, allow for chemical denervation of brow depressor muscles. This has become a truly non-invasive way to address minor forms of aging of the forehead and brow. However, for advanced cases, open brow lift remains a powerful technique which should remain in the arsenal of the plastic surgeon. This review contains 3 figures, 2 tables, and 39 references. Keywords: cosmetic surgery, facial plastic surgery, facial aging, brow ptosis, rhytids, facial nerve, supraorbital nerve, supratrochlear nerve

The Open Browlift.

The eyes and periorbital areas are critical components for the harmonious treatment of the aging face. The authors prefer the open browlift for rejuvenation of the forehead area. The open browlift is the most versatile, effective, and long-lasting method for the treatment of the forehead. The analysis of the forehead area, alternative treatments, variations in incisions, and key components of the surgical procedure are to be reviewed.

Upper Eyelid Fat Excision through a Brow-Lift Incision: An Investigation of Technique and Anatomic Landmarks

Introduction: Brow-lift and upper blepharoplasty are often done sequentially to achieve adequate rejuvenation of the upper face. We describe the feasibility of a novel method of addressing both the aged forehead and upper eyelid fat pseudoherniation via an open brow-lift approach. Materials and Methods: We performed our technique on 6 cadaver and 3 human subjects. A brow-lift was performed in open fashion followed by upper eyelid fat excision through the superiorly exposed orbital septum. Position of the orbital fat from this approach and its ease of excision were recorded. Results: In all cases, the medial and central fat compartments were medial and lateral to the supraorbital nerve, respectively. Fat was accessible and amenable to excision from this approach. There were no complications related to this technique. Conclusions: When upper eyelid dermatochalasia is resolved when an open brow-lift is performed, this technique addresses upper eyelid fat pseudoherniation through the same brow-lift incision. Although this procedure is feasible and safe, long-term results in a greater number of patients are needed to confirm its role in aesthetic surgery.

Cosmetic Facial Surgery

Dermatologic Surgery: September 2011 - Volume 37 - Issue 9 - p 1320 doi: 10.1111/j.1524-4725.2011.02104.x

Forehead and Scalp Sensation After Brow-lift

Objective To compare postoperative forehead and scalp sensation for the “open” brow-lift (OBL) (coronal and trichophytic) with that of the endoscopic brow-lift (EBL). Methods A controlled outcome e...

The Sentinel Fat Pads: The Relationship of the ROOF and SOOF to the Temporal Nerve in Facial Rejuvenation

A great number of studies have reported on the temporal branch anatomy and its relationship to the fascial layers and various fat pads of the temporal region, but no article has included information on the relationship of the temporal nerve to the retro-orbicularis oculi fat (ROOF) and/or the suborbicularis oculi fat (SOOF). The authors report the results of a series of human cadaver temporal nerve dissections, with particular attention paid to its relation to the ROOF and the SOOF. The results of a literature review and a subsequent open browlift are also reported to confirm the results of the cadaver study. Dissection was performed on 15 fresh human cadavers, for a total of 29 hemifaces. The course and relationships of the temporal nerve branch to the fascia, fat pads, and landmarks in the temporal region were noted and detailed. A thorough review was also performed for 23 articles, to compare the author's anatomical findings with data in the previous literature. During cadaver dissection, the temporal branch was found to lie on the undersurface of the superficial temporal fascia. In the supraorbital area, the ROOF existed in the loose areolar plane or deep layer of the superficial temporal fascia, with the temporal nerve branch directly superficial to it. The temporal branch passed lateral to the SOOF in its superiomedial course at the level of the zygoma. These findings were later confirmed during an in vivo open browlift as well. The ROOF was formerly unrecognized as an important sentinel marker for possible injury to the temporal nerve branch during browlift. However, this cadaver study and its accompanying literature comparisons show that browlift dissection, whether endoscopic or open, should aim to keep the ROOF fat in the superficial plane, ensuring that the nerve branch is safe from iatrogenic injury.

Forehead and Scalp Sensation After Brow-lift

To compare postoperative forehead and scalp sensation for the "open" brow-lift (OBL) (coronal and trichophytic) with that of the endoscopic brow-lift (EBL). A controlled outcome evaluation study was designed to objectively (mechanoceptive and thermoceptive) and subjectively (visual analog scale) test forehead and scalp sensation in a group of patients having undergone or scheduled to undergo either OBL or EBL in a single, private facial plastic surgery clinic. Prospectively enrolled participants were tested at defined intervals (A, preoperation; B,1-2 weeks after; C, 4-6 weeks after; D, 12-14 weeks after; and E, 24-26 weeks after). To provide extended follow-up data (≥6 months), patients returning for scheduled follow-up examination who had already undergone either OBL or EBL were subjected to the same test battery. For statistical analysis of the extended follow-up data, the participants were divided into 2 groups (F, 6-18 months; and G, >18 months). The null hypothesis was that there would be no measurable difference between the OBL and the EBL groups related to postoperative forehead and scalp sensation. Twenty-one individuals (EBL, n = 11; OBL, n = 10) were enrolled prospectively. All showed normal objective and subjective values preoperatively. While both groups objectively and subjectively demonstrated decreased sensation over follow-up, the OBL group showed statistically significant decrement in objective scalp sensitivity at times B, C, and D vs the EBL group. Subjectively, the OBL group felt less sensitive than the EBL group at times C and D. Those relationships disappeared at time E. Fifty-eight individuals were retrospectively enrolled. At time F (EBL, n = 16; OBL, n = 10), an objective and subjective difference was again observed with the OBL group demonstrating less scalp sensitivity vs the EBL group. At time G (EBL, n = 20; OBL, n = 12), this difference was no longer observed. We reject the null hypothesis and state that there is a measurable, statistically significant difference between the studied groups related to postoperative forehead and scalp sensation and that those observed differences are objective and subjective in nature as well as time dependent. However, almost no patients (57 of 58), irrespective of the technique used for their brow-lift, viewed their experienced forehead and/or scalp numbness to have been significant enough to deter them from undergoing the surgery again.

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.

Aesthetic Considerations in Male Facial Rejuvenation

Ronald E. Iversion, MD Mark A. Codner, MD Val S. Lambros, MD Gregory S. LaTrenta, MD Dr. Iverson: The first patient is a 59-year-old man who feels that his fatty cheeks and heavy nasolabial folds make him look aged (Figure 1). He would like to look completely rejuvenated. Dr. Lambros, what would your preoperative plan include? Figure 1 Preoperative views of a 59-year-old man who feels that his fatty cheeks and heavy nasolabial folds make him look aged. He desires complete facial rejuvenation. Dr. Lambros: First, we must be sure that he has realistic expectations. In my experience, and in presentations by other surgeons, I have not seen a lot of success in elevating lateral brows in patients with thick foreheads. In this patient, I would elevate the medial brows to get rid of that “cranky” expression, which I believe could be accomplished without brow distortion. One could perform a corrugator resection through the upper lid, come down from above with an endoscope, and get some support. Alternatively, an open-brow lift would be reasonable, as would an upper-lid blepharoplasty. He would need a face and neck lift with the best possible internal support. I would perform a modest amount of jowl liposuction at the same time. My main indication for opening a neck is platysma bands. Otherwise, I would simply liposuction the neck. Dr. Iverson: How would you manage the lower eyelids? Dr. Lambros: This is a patient in whom I think “doing no harm” is a good idea. He has a small amount of lateral sway in his lower lids, and my temptation might be just to perform a canthopexy and not do anything more aggressive with the lower lids. Dr. Iverson: Dr. Codner, what would you do differently? Dr. Codner: This patient has a narrow brow-lash distance, as demonstrated on …

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 …