Transcalvarial Suture Fixation for Endoscopic Brow and Forehead Lifts

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.

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

Facial thread lifting is currently very popular as a minimally invasive procedure. This retrospective study assesses the clinical efficacy of PLLA/PLGA coned threads used in patients who underwent thread brow lifting. Forty-two patients with mild-to-moderate brow ptosis were treated with PLLA/PLGA coned threads for brow lifting as an outpatient procedure. Progress was evaluated with FACE-Q scales (satisfaction with face appearance, appraisal of upper eyelids, and satisfaction with forehead and eyebrows) and the Brow Positioning Grading Scale at baseline, 6, 12, 18, and 24 months after the procedure. All patients (30 female and 12 male) were satisfied with the procedure's outcome. There was a statistically significant improvement in all Face-Q scales in all enrolled patients during the study period of 24 months. Scores of Brow Positioning Grading Scales (BPGS) paralleled the Face-Q scores (p < 0.05); however, the scores tended to worsen likewise after the 18th month. No serious adverse events were noted. Minor adverse effects were bruising, swelling, erythema, dimpling, and asymmetry. In patients with mild-to-moderate brow ptosis, absorbable PLLA/PLGA sutures are an important, efficient, and valuable option for repositioning facial tissues. They also meet patients' expectations and ensure high patient satisfaction, as shown by Face-Q scores. IV. 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 .

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.

Olecranon fractures are relatively common injuries, accounting for approximately 10% of upper extremity fractures in adults [26]. These fractures may result from a direct blow to the proximal ulna, or indirectly, via the forceful contraction of the triceps against resistance (typically, during a fall onto an outstretched hand). Less commonly, the olecranon may fracture when the elbow is hyperextended, as the bone is impacted against the olecranon fossa of the distal humerus. For unstable injuries, operative fixation typically is required. Even after recovery, loss of ROM is not uncommon. This article provides an overview of olecranon fractures in adults; therefore, discussion of olecranon fractures in skeletally immature patients is beyond the scope of this article.

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.

Background Screw and suture fixations are the most commonly used methods of fixation in treatment of anterior cruciate ligament tibial avulsion fractures. Even though a few biomechanical studies have compared the stability of the 2 fixation techniques, a clinical comparison has not yet been reported. Hypothesis The authors hypothesized that both fixations would be identical in all studied clinical outcome measures at a minimum 2-year follow-up. Study Design Cohort study; Level of evidence, 3. Materials and Methods Thirty-three patients treated with either screw fixation (16 patients) or suture fixation (17 patients) within 1 month of the anterior cruciate ligament tibial avulsion fracture (type II or III) without associated ligamentous injury were included. All patients were evaluated at a minimum 2-year follow-up in terms of Lysholm knee scores and return to preinjury activities. Knee stability was compared based on the Lachman test and stress radiography. Results No significant differences were found between the 2 groups in terms of average Lysholm knee scores (91.7 in the screw group and 92.7 in the suture group, P = .413) at follow-up. All patients except 2 (1 in each group) returned to preinjury activity levels. However, flexion contractures (5° to 10°) were found in 3 patients in the screw group and 2 patients in the suture group without significant intergroup difference. Stabilities based on the Lachman test and instrumented stress radiography were also similar between the 2 groups at follow-up. However, 2 patients in the screw group and 1 in the suture group showed more than 5 mm laxity compared with the contralateral knee on stress radiographs. Conclusion Both the screw and suture fixation techniques for the anterior cruciate ligament tibial avulsion fracture produced relatively good results in terms of functional outcomes and stability without any significant differences. However, some patients in both groups showed residual laxity or flexion contractures.

Single column plate plus other column lag screw fixation vs. both column plate fixation for anterior column with posterior hemitransverse acetabular fractures - a biomechanical analysis using different loading protocols.

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.

Endoscopic forehead rejuvenation for the oral and maxillofacial surgeon

Retrograde intramedullary headless compression screw fixation for distal fibular fractures.

In recent years, the endoscopic technique has emerged as a minimally invasive approach to forehead rejuvenation, although the specific need for and mode of brow fixation for endoscopic brow lifts remain under considerable debate. An ideal fixation device should provide non-palpable long-lasting fixation and allow retention of the device post-operatively without the need for removal. It should also allow precise intraoperative adjustment for symmetry and correction of brow ptosis. The authors describe an endoscopic brow lift technique using an absorbable bone anchor, Mitek Microfix. A retrospective chart review was conducted in patients who underwent endoscopic brow lift procedures utilizing this fixation method at an academic practice. Outcomes evaluated included operative times, reoperation rates, palpability, fixation device permanence, incremental costs comparisons to conventional methods, efficacy, and technical learning curve. Complication rates were evaluated and the economic, incremental cost analysis of current fixation methods was reviewed. Eighty-two patients underwent single-procedure endoscopic brow fixation using the Mitek anchor over a 9-year period (2005-2014). The mean operative time was 100 minutes. There were no cases of implant palpability, alopecia, or other postoperative complications. Two patients underwent revision secondary lifts after an average of 5.5 months for temporal ptosis. The Mitek Microfix QuickAnchor provides durable, long-lasting fixation without device palpability. Its technical ease of use is demonstrated by the reasonable mean operative time achieved with the active involvement of resident surgeons. This device is operator-friendly, easy to use, fully indwelling, and provides lasting fixation without the development of palpability or alopecia.

Endoscopic Brow Lifts: Have They Replaced Coronal Lifts?