Suture fixation technique for endoscopic brow lift

Abstract

Endoscopic brow lift has become widely accepted as a procedure for restoring a youthful brow, as only three, 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. Endoscopic brow lift allows separation and repositioning of the periosteum of the orbital rims and zygomaxilla. In a 7-year period beginning September 1999, 350 patients underwent endoscopic brow lift. In these patients, we used our fixation approach, which was accomplished with an absorbable suture subperiosteally. Satisfactory forehead rejuvenation was obtained in all patients with correct eyebrow movement. Long-term results over 7 years confirm the strength and durability of our fixation approach. We consider this approach to be a simple, fast, and reliable fixation technique that establishes precise, secure, and direct brow fixation that allows satisfactory and long-lasting cosmetic results.

Keywords: Suture fixation; endoscopic brow lift.

Figure 1

Lateral incision over the temporalis muscle. It is a posterior and parallel to the hair line 2- to 3-cm incision in the scalp.

Figure 2

Subperiosteal release and elevation of the tissues. Dissection is beneath the pericranium and carried down to the original rims and the zygomatic arch anteriorly.

Figure 3

Through a 2-mm skin incision (at the level of the tail of the eyebrow), with an endoscopic grasper, one suture is passed throughout the periosteum and galea. We use coated Vicryl 2-0 (polyglactin 910).

Figure 4

The suture is placed through the skin in and out of the same puncture hole, through the skin but encircling the fascia above the orbital rim.

Figure 5

The stitch is secured to the galea of the posterior edge of the lateral incision.

Figure 6

When the knots have been made, leaving enough stitch, the excess tissue is resected in an inverted-T way.

Figure 7

If necessary, additional fixation may be used for the head of the brow at the median incision site.

Figure 8

Preoperative appearance (above) and 1-year postoperative appearance (below) after EBL using our fixation technique and upper and lower blepharoplasty.

Figure 9

Preoperative appearance (left) and 3-year postoperative appearance (right) after EBL using our fixation technique.

Figure 10

Preoperative appearance (left) and 1-year postoperative appearance (right) after EBL using our fixation technique. The patient also underwent face lift and upper and lower blepharoplasty in both eyes.

Figure 11

Preoperative appearance (above) and 6-month postoperative appearance (below). Combination of EBL with our fixation technique, face lift, and unilateral upper and lower blepharoplasty.

Figure 12

Preoperative appearance (above) and 2-year postoperative appearance (below) after EBL using our fixation approach and lower blepharoplasty in both eyes.

Figure 13

Preoperative appearance (above) and 2-year postoperative appearance (below) after EBL using our alternative fixation approach, face lift, and upper and lower blepharoplasty in both eyes.