An alternative fixation technique for the endoscopic brow lift

BACKGROUND: Endoscopic brow lift has become widely accepted as a procedure for restoring a youthful brow, since only 3 hardly noticeable incisions of the scalp are needed for this subperiosteal dissection and final repositioning of the brow. It has become an acceptable technique, an alternative to the conventional technique or transcoronal browpexy. One of the controversial points is the fixation of the flap in the elevated position. METHOD: Endoscopic brow lift allows separation and repositioning of the periosteum of the orbital rims and zygomaxilla. In a 6-year period from September 1999, 300 patients underwent endoscopic brow lift using our fixation approach, which was accomplished with an absorbable suture subperiosteally. RESULTS: Satisfactory forehead rejuvenation was obtained in all patients, with correct eyebrow movement. CONCLUSIONS: Long-term results of 6 years confirm the strength and durability of this fixation approach. We consider this approach to be a simple, secure, and reliable forehead fixation method, an alternative to other fixation methods, that allows satisfactory and long-lasting cosmetic results.     

Concurrent brow lift and blepharoplasty with a resorbable fixation device

Background

Ageing changes on the forehead and the periocular area are of much concern to the patient not only from an aesthetic but a functional point of view as well. Many techniques exist for correction of upper periorbital ageing changes. We hereby present our technique of doing a brow lift and upper lid blepharoplasty as a combined procedure using a resorbable fixation device.

Methods

We carried out the study over a period of 36 months from July 2008 to July 2011. Only the patients requiring both brow lift and blepharoplasty were included in the study. Brow lift was performed through the upper lid blepharoplasty incision, and elevation was maintained by the resorbable fixation device screwed into the frontal bone. Following this, excess upper lid skin and muscle was excised to complete the upper lid blepharoplasty.

Results

A total of 25 cases including 17 females and 8 males were operated. The age ranged from 39 to 74 years, and the mean age was 54 years. Seven patients required both upper as well as lower lid blepharoplasty along with a brow lift, whereas 18 patients underwent only upper lid blepharoplasty along with a brow lift. In two of the patients who had a predominantly medial brow ptosis, we placed the Endotine device over the medial eyebrow. All patients were satisfied with the final result, and the device became impalpable over a period of 1 year.

Conclusions

The technique described is simple, reproducible and quick for addressing the upper lid and brow in one surgical sitting. A thorough preoperative discussion and demonstration of achievable result to the patient along with thorough understanding of the anatomy is the key to success.

Level of Evidence:

Level IV, therapeutic study.     

Secondary endoscopic forehead lift in patients with previous coronal brow lifts

INTRODUCTION: The development of endoscopic surgical techniques has allowed an evolution from the standard coronal forehead lift to a minimally invasive one. Endoscopy avoids many of the undesirable results of the coronal approach while it remains very efficacious. The purpose of this study is to evaluate the effectiveness and safety of endoscopic forehead lift in patients who have previously undergone coronal brow lift. MATERIALS AND METHODS: A retrospective review was performed on the medical records of 726 consecutive patients who had undergone endoscopic forehead lift between 1994 and 2004. Sixty-three patients were identified who had undergone prior coronal incision brow lift and then required subsequent elevation of the forehead using endoscopy. Those who had persistent low eyebrows and forehead wrinkles underwent the standard minimal incision endoscopic approach. Patients with severe brow ptosis and excessive height of the forehead underwent a biplanar endoscopic forehead lift. RESULTS: Of the 63 endoscopic forehead lifts performed, 49 used the minimal access technique, while 14 employed the biplanar approach. The subject population consisted of 58 female and 5 male patients whose average age was 57 years (range of 42 to 80 years). Eighty-seven percent of these brow lifts also had concomitant rhytidectomy, and 4% had blepharoplasty. Average follow-up was 21 months (range 1 to 7 years). Following the endoscopic procedure, none of the patients had frontal nerve injury, alopecia, or persistent glabellar wrinkle lines. Complications included 1 forehead dysesthesia, 1 forehead irregularity, 1 eyebrow malposition, 1 persistent horizontal forehead wrinkling, and 2 hematomas. Operative management was not required for any of these complications. CONCLUSION: The secondary endoscopic forehead lift is effective in rejuvenating the upper face in the patient who has had a previous coronal forehead lift. It elevates the eyebrows and reduces both transverse and vertical wrinkles while avoiding further displacement of the hairline. The low rate of complications is comparable to that of primary endoscopic forehead lifts. Finally, serial follow-up indicates that the results are effective at correcting brow ptosis and are long lasting.     

A novel technique for repositioning lower eyelid fat via the transoral approach in association with midface lift

Background  

Orbital fat repositioning in association with subperiosteal midface elevation has been variably described via both the transconjunctival and skin muscle flap approaches. Poor visualization, middle and posterior lamellar cicatricial fibrosis, technical difficulty, and incomplete release are disadvantages commonly ascribed to the transconjunctival approach. Lower eyelid malposition and retraction also are commonly seen in association with skin muscle flap approaches. A simple technique using the intraoral approach to release the orbital septum and postseptal fat is described in this report. This procedure avoids complications associated with the violation of key lower eyelid anatomic structures and markedly improves visualization through an incision allowing a much larger access.     

Current practices in endoscopic brow and temporal lifting.

This article describes new innovations in the endoscopic treatment of the ptotic brow and temple. Extensive release of upper midface ligamentous structures and wide undermining of the orbicularis oculi are maneuvers that have been added to the standard brow lift procedure. Suspension sutures have improved brow tail and cheek fat elevation. Radiofrequency instrumentation and fibrin glue have allowed the minimization of tissue trauma during depressor muscle lysis and brow and temple fixation. Brow lowering techniques also have been developed to reverse the effects of aggressive endoscopic and coronal brow lifting.     

Use of BioGlue surgical adhesive for brow fixation in endoscopic browplasty

OBJECTIVE: To determine the efficacy, longevity, and safety of BioGlue Surgical Adhesive for periosteal fixation in endoscopic browlifts. METHODS: Retrospective review of 80 patients who underwent endoscopic browlift using BioGlue as the primary means of periosteal fixation. Visits were categorized as preoperative, 1 to 2 months, 3 to 6 months, and 7 to 12 months, and photographs of the first 15 patients were evaluated for change in brow position at each of these visits. Brow position was measured at the lowest brow hairs at the midpupillary and lateral canthus positions. Follow-up was 3 months to 3 years. RESULTS: All of the first 15 patients were included in the 1- to 2-month postoperative grouping, 13 in the 3- to 6-month grouping, and 10 in the 7- to 12-month grouping. At all postoperative visits, brow elevation was significantly maintained during 12-month follow-up. Revision has been required in only 1 of 80 patients to date. CONCLUSIONS: BioGlue is an effective and safe method of maintaining brow position in endoscopic browplasty. Brow elevation achieved using BioGlue was significantly maintained during the 7- to 12-month postoperative period. Tissue adhesives such as BioGlue have the potential to become significant adjuncts in facial plastic surgery and warrant more critical evaluation.     

Evolution of endoscopic urethropexy: seven-year experience with various techniques

The surgical techniques for correction of stress urinary incontinence continues to evolve particularly those utilizing the endoscopic approach. Various forms of endoscopic urethropexy have been performed in 142 women with a minimum of one-year follow-up. The cure rate for the entire series was 94 percent. In the last two years the no-incision technique was used whenever feasible (31 patients) with an identical cure rate of 94 percent. Varying degrees of urinary retention occurred in 58 percent and was even more prevalent following the no-incision technique (68%). Owing to the high incidence of urinary retention a punch suprapubic cystostomy is now used in most patients. We conclude that endoscopic urethropexy is an effective means of correcting stress urinary incontinence. The no-incision technique is associated with even less morbidity and a reduction in hospital stay without compromising the outcome.     

Role of deep temporal lift in the surgical treatment of face aging]

This is a new technique which is completely different from superficial temporal facelift also referred to as the mannequin facelift, which is associated with well known failures and sequelae. The principle of the deep temporal facelift is to approach the deep surface of the musculoaponeurotic plane by remaining in contact with the bone and to attach the ascension of this plane by means of sutures anchored to the temporalis mucsle and fibrin glue. This operation is technically possible due to the use of the dissectable space described by Rouvière between the galea and the temporalis muscle. This virtual, detachable space can only be easily defined by the use of hydrodissection. It is an avascular space with the exception of an unnamed vein located at the external agnle of the orbit. There is no resection of the scalp, no modification of the hairline and no modification of the sideburns. The frontal branch of the facial nerve constitutes the anatomical danger. It is situated anterior to the superficial temporoparietal aponeurosis which prolongs the galea. The two danger zones are the zygomatic arch which is crossed by the frontal nerve trunk and a quadrilateral area between the hairline and the tail of the eyebrow and a vertical line 1.5 cm lateral to the lateral canthus of the eye. The frontal nerve does not constitute any risk during deep temporal facelift, as this procedure remains about 1.5 cm away from the zygomatic arch. The nerve is obviously more superficial in the quadrilateral area. To avoid damaging it, the dissection must be performed under direct vision using a cold light, remaining in contact with the temporalis aponeurosis and avoiding any untimely instrumental manoeuvre between a subaponeurotic metallic instrument and the stretched skin. This technique causes minimal discomfort to the patient. It can be performed under local or general anaesthesia. The hospital stay is brief and the postoperative course is extremely straightforward with a very limited risk of bruising. The deep temporal facelift can be combined with the subpalpebral facelift in order to act on the upper 2/3 of the face. Its essential indications are: drooping of the tail of the eyebrow, drooping of the external canthus of the eye, erows feet.     

五种颈椎内固定方法的稳定性生物力学评价

目的 比较不同颈椎内固定器械的稳定性能,为临床合理选择的固定提供生物力学基础。方法 ８具新鲜颈椎标本,制成Ｃ４,５节段三柱损伤模型,分别用钛制带锁螺钉钢板,钛制带锁螺钉钢板加棘突间钢丝,棘突间钢丝,Ｒｏｙ－Ｃａｍｉｌｌｅ钢板和椎弓根螺钉钢板５种方法固定,测试它们在前屈,后伸,左右侧弯和轴向旋转运动状态的稳定性能。结果 单纯钛制带锁钢板和棘突钢丝固定的三维运动稳定性尚不及椎完整模型的稳定性;钛制带锁     

Male face lift in continuity with lower blepharoplasty

Rhytidectomy in the male is always more complicated than in the female. We present important modifications of the usual female-type face lift procedure that solve problems peculiar to the male patient. We describe a combined procedure of male rhytidectomy in continuity with the lower blepharoplasty incision. This technique increases the aesthetic results significantly. It provides an increased mechanical advantage in rotation and elevation of the cheek flap which is necessary to correct adequately the frequent redundancy and marked sagging in the lower face and neck often witnessed in the aging male patient. The preauricular non-hair-bearing portion of skin is left undisturbed with no change in the appearance of the sideburn. There is no elevation of the temporal hairline. The operative technique is fully described with emphasis on the complications we observed and how to avoid them. The results presented justify the slightly visible scarring that may occur in the temporal area which heals extremely well and is very acceptable aesthetically.Presented at the Foundation for Facial Plastic Surgery: The Latest Advances in Cosmetic Surgery of the Face, Newport Beach, CA, August 9, 1987     

SMAS层叠固定术在眉和上睑年轻化手术中的应用

目的：寻找一种治疗中年眶周老化病人的简单而有效的门诊手术方法。方法：通过眉整形切口应用SMAS层折叠方法对一组病例进行治疗，并进行术后满意度问询和随访。结果：本组66例病人手术后对效果满意，并发症少，随访6～24个月，术后瘢痕小，疗效持久。结论：该手术创伤小，效果持久，可以推广应用。     

Valvuloplasty and fixation of the femoral vein for valvular incompetence of deep veins of the lower extremity

Fifty cases (54 limbs) of valvuloplasty and fixation of the incompetent valve of the femoral vein were reported. Diagnosis was made by clinical features, measurement of ambulatory venous pressure, ascending and descending phlebography, and by intraoperative checking the blood flow. After repairing the highest primary valve of the superficial femoral vein a circular suture around the vein at 2 mm under the repaired valve was made to prevent the recurrence of valvular incompetence. Patients were followed-up for 6 to 45 months (mean 20.2 months) with satisfactory results in all and excellent in 50 limbs (92.6%). The swelling subsided, stasis dermatitis and ulcer healed promptly, the "heavy leg" became light, and venous pressure of post-exercise lowered significantly (P less than 0.01). No retrograde flow of contrast medium was detected during the descending phlebography after operation. The results suggest that this operation is better than simple repair of the incompetent valve.