Preoperative Classification System Used to Determine Release Performed during Endoscopic Brow Lift

The techniques presented in article will allow the facial plastic specialist to use the anatomy of each individual patient as a guide for the surgical release of the brow performed during endoscopic brow lift. The author presents his 15 years of experience in which he developed this approach. Five different surgical releases of the brow will be demonstrated and discussed in terms of which patients would best benefit from which release. Adopting this approach has made the predictability of the authors brow lift results much better and therefore improved patient satisfaction. This concept has not been described in the literature and the author firmly believes using a preoperative anatomical approach is a better way to approach endoscopic brow lift surgery.

Investigating Long-Term Brow Stabilization by Endotine-Assisted Endoscopic Brow Lift with Concomitant Upper Lid Blepharoplasty

Objective: To determine whether Endotine-assisted endoscopic brow lift with concomitant upper lid blepharoplasty provides long-term brow elevation. Methods: 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. Results: 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. Conclusion: 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 Brow Lift Without Muscle Resection: Objective and Subjective Changes in Intereyebrow Width

The purpose of this study is to evaluate the objective and subjective changes in medial intereyebrow distance following endoscopic brow lift without corrugator resection. The authors designed a retrospective cohort study. The eligible patients included those receiving endoscopic brow lifts at Williamson Cosmetic Center in Baton Rouge, LA between June 1, 2014 and March 31, 2018. The primary outcome variable was the distance between the left and right medial brow. The secondary outcome variables were nonsurgeon evaluator’s perception of the change in intereyebrow distance and the aesthetics of the intereyebrow region. The relationship of the outcome variables to the primary predictor (time point—preoperative and postoperative) was analyzed using paired sample t-tests. The relationship of the outcome variables to the other predictors was analyzed using Pearson correlations. A P-value of less than .05 was considered significant. A total of 41 patients were included in the study. The average age was 55.3 ± 8.5 years and all patients were women. The average time from surgery to postoperative photos was 6.2 ± 3.2 (range: 3-15) months. The average preoperative intereyebrow width was 31.5 mm, and the average postoperative width was 33.1 mm ( P < .0001). Correct perception of the intereyebrow change was found to be positively correlated with increasing patient age ( P = .047) and increasing change in intereyebrow width ( P = .008). The intereyebrow distance was perceived as aesthetic for 73.4% ± 31.0% of preoperative patients and 76.1% ± 27.6% of postoperative patients ( P = .346). Patients with a preoperative intereyebrow distance perceived as aesthetic are very likely to be perceived as aesthetic postoperatively (correlation coefficient 0.817, P-value < .0001). Following endoscopic brow lift without corrugator muscle resection, there is a small, but statistically significant increase in the intereyebrow distance. However, this change was not associated with negative perception of the aesthetic appearance of the intereyebrow region.

The K-Wire Fixation Technique for Endoscopic Brow Lift: A Long-Term Follow-Up

Background Many techniques have been presented for fixation during endoscopic brow lift, but no singular technique has become dominant. Objectives The authors described a technique for fixation for endoscopic brow lift that is inexpensive, easy to use, and versatile and has minimal morbidity. Methods The charts of 284 patients who underwent the K-wire fixation technique between December 1996 and September 2018 were reviewed. This technique employs a transcutaneous K-wire to hold the brow in position until tissue adhesion creates a lasting elevation of the brow. Results A total of 284 patients underwent K-wire fixation for endoscopic brow lifting. Two patients had hematomas and 5 patients (1.8%) required a second unilateral brow lift procedure. Long-term elevation of the brow was maintained in all patients. Conclusions K-wire fixation for endoscopic brow lift is a simple, safe, and effective technique for fixation during endoscopic brow lifting that provides long-term aesthetic results. Level of Evidence: 4