Subperiosteal Brow Lifts without Fixation

Background: The goals of any brow-lifting procedure are to stabilize the brow at an aesthetically ideal height, orientation, and provide reproducible and lasting results while concealing scars and avoiding the stigmata of a facial plastic surgery: hairline elevation, over-elevated brows, or a quizzical appearance.Aim of the study:This study was designed to evaluate the efficacy and safety of using the endoscopic approach in brow lifting surgery.Patients and Methods:This prospective intervention study involved twenty patients who underwent endoscope temporal brow lift at Al-Shaheed Ghazi Al-Hariri hospital and the burn center at Baghdad Medical Complex between October 2020 and June 2022. Twenty patients were included, and surgical intervention for temporal brow lift was done using an endoscope. The patients were assessed before surgery and monthly until 6 months after.Evaluation of all the patients has been advocated objectively and subjectively. The distance (in mms) between the nasal ala and the lateral tail of the brow and the vertical distance between the lateral tail of the brow and the lateral canthus were used as an objective evaluation method.Visual Analogue Scale was used to evaluate the perception of the patients, the surgeon, and the third eye (another surgeon) after the post-operation.Results:In objective evaluation, the mean gain of the distance between the nasal ala and the lateral tail of the brow is 8 mm, the mean increase in the vertical distance between the lateral tail of the brow and the lateral canthus is 6.5 mm. Regarding subjective perceptions using VAS, most patients have good perceptions, while most surgeons’ perceptions are perfect. No major complications were faced in our patients, perhaps due to the lack of complexity, such as calvarial interventions, and avoidance of using biodegradable implantable devices. Conclusion: Endoscopic temporal brow lifting is a minimally invasive option with a smooth postoperative recovery that can provide promising aesthetic results. However, larger series of patients and more extended periods are needed for more precise evaluation.

We placed negative electrodes on the body and positive electrodes at the medial and lateral canthi, measured their potentials separately, evaluated their characteristics, and analyzed cross-talk. We recorded EOG in 6 normal subjects and found the following. The potential at the medial was lower than that at the lateral canthus in the bilateral eyes. The polarity of waves at the lateral was reverse to that at the medial canthus in the bilateral eyes. We recorded EOG in 6 patients with unilateral anophthalmia and found the following. On the anophthalmia side, the potential at the lateral was considerably lower than that at the medial canthus. The polarity of the potential was the same between the medial and lateral canthi. The mean cross-talk to the medial canthus on the anophthalmia side was 8.7%-54.0% of the potential at the medial canthus on the normal side. The mean cross-talk to the lateral canthus on the anophthalmia side was 4.4%-16.9%. The influence of cross-talk of the other eye was marked at the medial but slight at the lateral canthus. In EOG recording, results with minimum errors due to cross-talk can be obtained by paying attention to the potential at the lateral canthus.

11 - Forehead rejuvenation

Various techniques have been described for periorbital rejuvenation and correction of the ptotic brow, including the coronal brow lift, the endoscopic brow lift, anterior hairline foreheadplasty in the subgaleal, subperiosteal, or subcutaneous planes, and the subcutaneous temporal brow lift. The authors present results from a series of 28 patients treated with subcutaneous temporal brow lift over nearly four years. A retrospective chart review was conducted of 28 patients who were treated with subcutaneous temporal brow lift by the senior author (JDF) between July 2003 and January 2007. All patients underwent the same subcutaneous temporal brow lift procedure under local anesthesia in an office-based setting. No combined procedures were performed on any of the patients in this series. Of the 28 patients, 27 were female and one was male; mean age was 54 years. Five patients underwent a unilateral brow lift for asymmetry and 23 patients underwent a bilateral procedure. The mean length of follow-up was 10.8 months. Scarring was minimal and rated as "good" or "excellent" by both patients and surgeon. The effectiveness of the browlift was also rated as "good" or "excellent" by all but one patient. Two patients underwent revision-one for scar revision and the other for a greater degree of lift. There were no incidences of hematoma, infection, numbness, or excessive scarring. The subcutaneous temporal brow lift is an effective, reproducible, and inexpensive technique that can be performed safely under local anesthesia.

Understanding the impact of eyebrow and lateral canthal height on the perception of character traits: A rating-based analysis of 2081 participants.

Long-term stability and recurrent ptosis are among the most debated topics in endoscopic brow lifts. Although there are many publications on endoscopic brow lifts, more research is needed on long-term brow elevation and stability. This systematic review aims to evaluate the amount of elevation and stability achieved by endoscopic brow lifts in the long term. To evaluate the long-term outcomes of endoscopic brow lifts, the databases 'Pubmed', 'Web of Science', 'Scopus', and 'Google Scholar' were searched using the keywords 'endoscopic brow lift', 'endoscopic forehead lift', 'forehead lift', 'foreheadplasty', 'brow lift', 'endoscopic brow fixation', and 'brow fixation'. Studies published between September 1994 and May 2024, including isolated or combined endoscopic brow lift surgeries, were included. 5324 articles were screened, and 85 full texts were reviewed. Of these studies, 12 (14.1%) were found suitable for systematic review and meta-analysis. Brow elevation values were evaluated separately for medial, central, and lateral parts. The pooled effect sizes for medial, central, and lateral brow elevations were found to be 3.25 mm (2.44-4.06), 3.86 mm (2.93-4.8), and 4.35 mm (3.06-5.64), respectively. This study is the first meta-analysis to present the average elevation values that can be achieved in the long term in endoscopic brow lifts. These data guide a better understanding of the patient candidates and the technique for endoscopic brow lifts. Sharing more objective data over the long term with different fixation methods will contribute to a better understanding of the criteria related to the indication of this surgery.

Patients often develop eyebrow drooping after blepharoplasty or ptosis repair. After aponeurosis advancement was performed in 53 patients (100 eyelids) with blepharoptosis, the eyebrow heights at the medial canthus, center of the pupil, and lateral canthus were measured using scanned photographs obtained preoperatively and 3 months postoperatively. In the 100 eyelids subjected to aponeurosis advancement, the eyebrow position was lowered at the medial canthus in 81 eyelids (81%), at the center of the pupil in 84 eyelids (84%), and at the lateral canthus in 80 eyelids (80%). The mean distance of eyebrow drooping in the 100 eyelids was 2.80 mm at the medial canthus, 2.87 mm at the center of the pupil, and 2.50 mm at the lateral canthus. The preoperative margin reflex distance (MRD) was significantly associated with the distance of eyebrow drooping at the medial canthus, the center of the pupil, and the lateral canthus in the 100 eyelids, but the postoperative MRD was not significantly associated with these parameters in the 100 eyelids. In conclusion, eyebrow drooping developed after aponeurosis advancement in most cases, and the distance of eyebrow drooping was associated with the severity of blepharoptosis.

Brow lifting techniques have applications in periorbital facial rejuvenation, establishing improved symmetry, and addressing sequela of facial paralysis. An understanding of fascial planes, mimetic muscles, and neural anatomy guides safe surgical planning. Preoperative assessment should include a thorough history, physical exam with focus on the upper horizontal third of the face, and photo documentation. Selection of operative technique and potential fixation should be individualized to the patient. Botulinum toxin can be used to elevate the position of the brows. This review contains 13 figures, 4 tables, and 29 references Keywords: brow lift, upper facial anatomy, facial analysis, brow lift surgical technique, brow lift surgical approach, endoscopic brow lift

The fascination with beauty attracts optimizations of surgical techniques. The eyelid-eyebrow region forms the emotional and expressive center of the human face. Aging causes a decrease in skin elasticity, allowing soft tissues to sag with gravity [1,2]. In this sense, surgical eyebrow lifts to improve aesthetics of the upper third of the aging face have been performed for several years. Current brow lift methods include direct brow lift, mid-forehead lift, coronal brow lift, and endoscopic brow lift [3-5]. Therefore, this technical article presents an optimization of the treatment of eyebrow tail ptosis using the modified direct brow lift technique by direct eyebrow elevation.

The Cavalieri method of modern design stereology has been used in combination with magnetic resonance imaging (MRI) to obtain unbiased estimates of the volume of the lumbar intervertebral discs immediately at the end of a day of normal activity and again following a night's rest. In addition, pixel-by-pixel mapping of the T2-relaxation time has been used to characterize objectively the tissues of the intervertebral discs. The mean increase in height of seven female subjects of average age 21 years (range 19-23 years) measured with a stediometer was 19.3 mm (range 8-26 mm). Image analysis showed that the mean overnight increase in volume of lumbar discs was 1300 mm3 (range 100-2700 mm3). The increase in volume of the disc was accompanied by an increase in the T2-relaxation time of the nucleus pulposus. This suggests that the change in disc volume is most probably caused by a preferential increase in the water content of the nucleus pulposus.

The purpose of this study was to evaluate the outcome of transphyseal ligament reconstruction in skeletally immature children with midsubstance anterior cruciate ligament (ACL) disruption. Five consecutive patients (mean age, 12.9 years; range, 8 to 14 years) with radiographically documented wide open growth plates and a minimum of 5 cm of expected remaining growth, underwent intraarticular reconstruction of the ACL. Operative treatment included three ACL reconstructions using hamstring tendons and two with quadriceps patellar tendon. All involved a centrally placed 6-mm or smaller tibial drill hole through an open physis and graft placement in an over-the-top position on the femur. At an average follow-up of 7.4 years (range, 4.5 to 9.9 years), no patient had a positive anterior drawer, Lachman, or pivot shift test. On KT- 1000 arthrometer testing, all patients had 3 mm or less of increased anterior-posterior displacement (mean ± SD=1.0 ± 1.6 mm). Magnetic resonance imaging showed that four tibial physes had fused in a symmetric fashion and one was still open. Orthoroentgenograms showed that no patient had a significant leg length discrepancy (−0.8 mm ± 3.4 mm). The mean increase in height postoperatively was 17.7 cm (range, 7.6 to 31.0 cm). Overall, using the International Knee Documentation Committee (IKDC) evaluation form, there were four patients with grade A and one with grade C. The one patient with a poor IKDC grade had sustained a subsequent patellar dislocation with osteochondral fracture. In conclusion, ACL reconstruction using small drill holes placed through open tibial physes does not seem to adversely affect outcome or future growth.

To determine whether Endotine-assisted endoscopic brow lift with concomitant upper lid blepharoplasty provides long-term brow elevation. Pre- and post-operative photographs from 35 patients who underwent endoscopic brow lift using Endotine Forehead 3 mm implants with concomitant upper lid blepharoplasty were measured to determine changes in brow height with surgery and up to 55 months post-operatively. Photographs of 20 control subjects who did not undergo periorbital surgery and 11 control subjects who underwent upper blepharoplasty without brow lifting were also measured to provide a basis for comparison. Emotrics software was used to perform automated brow height measurements in order to determine elevation and longevity achieved with endoscopic brow lifting in conjunction with upper lid blepharoplasty. There was a statistically significant increase in brow height post-operatively, averaging 1.6 mm (P < .0001, 95% confidence interval 0.95-2.18 mm). Fifty-four percent of patients had follow-up beyond 6 months post-operatively and 40% had follow-up beyond 1 year. Elevation remained stable over time with no statistically significant change across all serial post-operative visits. There was no statistically significant difference in brow elevation based on gender or age, or between right and left sides. Endotine-assisted endoscopic brow lift in conjunction with upper lid blepharoplasty provides modest brow elevation and long-term brow fixation as demonstrated by stable post-operative brow height measurements for up to 55 months.

The standard subgaleal coronal incision used for brow lifting is limited to patients with low foreheads. The subcutaneous hairline brow lift used for patients with high foreheads has a high rate of vascular complications. However, the main advantage of the subcutaneous approach is preservation of sensation posterior to the incision line. The subperiosteal approach, on the other hand, allows a better periorbital remodeling. I have combined the subperiosteal and the subcutaneous approach to take advantage of and minimize the disadvantages of each individual approach. The advent of the endoscopic technique has allowed more accurate and controlled periorbital dissection and brow depressor muscle modification. The operation is indicated in every patient in whom the anterior hairline incision is indicated. It is a good method for decreasing the height of the forehead. The dissection is done initially in the subcutaneous plane, and about halfway on the forehead slit incisions through the galea-periosteal layer and through the temporoparietal fascia are made to continue the dissection in the deep plane. The periosteal dissection and release at the arcus marginalis is done under endoscopic control. Likewise, the brow depressor muscle modification is done under endoscopic magnification. Deep anchoring sutures fix the brow in the elevated position. Trimming and closure of the cutaneous layer are done with minimal tension. The biplanar subperiosteal-subcutaneous forehead lift has been used in 24 patients with very satisfactory results. Complications have been of a minor nature. Patients have maintained sensation posterior to the hairline incision. The height of the forehead has been decreased in every case. Frontalis muscle function has been preserved.

Continuing Medical Education Examination—Facial Aesthetic Surgery In Pursuit of Optimal Periorbital Rejuvenation: Laser Resurfacing With or Without Blepharoplasty and Brow Lift

Physical height is an important measure of human capital. However, differences in average height across developing countries are poorly explained by economic differences. Children in India are shorter than poorer children in Africa, a widely studied puzzle called “the Asian enigma.” This paper proposes and quantitatively investigates the hypothesis that differences in sanitation — and especially in the population density of open defecation — can statistically account for an important component of the Asian enigma, India's gap relative to sub-Saharan Africa. The paper's main result computes a demographic projection of the increase in the average height of Indian children, if they were counterfactually exposed to sub-Saharan African sanitation, using a non-parametric reweighting method. India's projected increase in mean height is at least as large as the gap. The analysis also critically reviews evidence from recent estimates in the literature. Two possible mechanisms are effects on children and on their mothers.