Lateral Brow Lift: A Multi-Point Suture Fixation Technique

Abstract

Background: Descent of the lateral aspect of the brow is one of the earliest signs of aging. The purpose of this study was to describe an open surgical technique for lateral brow lifts, with the goal of achieving reliable, predictable, and long-lasting results.

Methods: An incision was made behind and parallel to the temporal hairline, and then extended deeper through the temporoparietal fascia to the level of the deep temporal fascia. Dissection was continued anteriorly on the surface of the deep temporal fascia and subperiosteally beyond the temporal crest, to the level of the superolateral orbital rim. Fixation of the lateral brow and tightening of the orbicularis oculi muscle was achieved with the placement of sutures that secured the tissue directly to the galea aponeurotica on the lateral aspect of the incision. An additional fixation was made between the temporoparietal fascia and the deep temporal fascia, as well as between the temporoparietal fascia and the galea aponeurotica. The excess skin in the temporal area was excised and the incision was closed.

Results: A total of 519 patients were included in the study. Satisfactory lateral brow elevation was obtained in most of the patients (94.41%). The following complications were observed: total relapse (n=8), partial relapse (n=21), neurapraxia of the frontal branch of the facial nerve (n=5), and limited alopecia in the temporal incision (n=9).

Conclusions: We consider this approach to be a safe and effective procedure, with long-lasting results.

Keywords: Eyebrow; Rejuvenation; Surgery, plastic; Sutures.

Fig. 1. Preoperative measurements and anatomical landmarks

Preoperative measurements of the distance between the peak of the eyebrow and the lateral canthus (h) were made using a digital caliper to serve as a reference during follow-up. The skin incision (dashed black line) was placed 5-6 cm posterior to the temporal hairline. The area of dissection (blue area), the fascial adhesions in the temporal fusion line (yellow), and the area of the supraorbital notch (red circle) are illustrated. ^*, condensation of fibrous tissue between the periosteum and the superolateral orbital rim.

Fig. 2. Lateral eyebrow elevation and fixation with sutures

(A) Three absorbable sutures (Vicryl 0, polyglactin 910) were passed through the periosteum and fascia of the superolateral orbital rim and secured to the galea of the posterior edge of the lateral incision. They were left long enough in the hair-bearing temporal area of the scalp to facilitate their subsequent removal two weeks postoperatively if any pinching of the skin was observed as healing progressed. (B) A patient in whom four sutures (Vicryl 0, polyglactin 910) were placed in a radial manner, achieving a wider vector of elevation.

Fig. 3. "Key" sutures

One or two additional absorbable mattress sutures (Vicryl 2-0, polyglactin 910) were placed between the temporoparietal fascia and the immobile deep temporal fascia. These are considered "key" sutures, as they bear the entire strain of the temporofrontal compound flap.

Fig. 4. Temporal skin excision

The excess skin in the temporal area was excised in a fusiform manner and the incision was closed with staples. The sutures that were left long enough (asterisk), are visible through the skin incision in the hair-bearing temporal area of the scalp.

Fig. 5. Lateral brow lift with upper and lower blepharoplasty

(A) Preoperative view. (B) Postoperative view after four years and three months.

Fig. 6. Lateral brow lift with upper and lower blepharoplasty

(A) Preoperative view. (B) Postoperative view after six months.

Fig. 7. Lateral brow lift with facelift and upper and lower blepharoplasty

(A) Preoperative view. (B) Postoperative view after seven years and one month.

Fig. 8. Lateral brow lift with upper and lower blepharoplasty

(A) Preoperative view. (B) Postoperative view after one month.

Fig. 9. Lateral brow lift with upper blepharoplasty

(A) Preoperative view. (B) Postoperative view after three years and five months.