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. 2019 May;27(2):100-106.
doi: 10.1177/2292550318800504. Epub 2018 Nov 4.

Endoscopic Brow Lift Fixation With Mitek Suture Anchors: A 9-Year Experience of a New "Ideal" Technique

Oluwaseun A Adetayo  1 , Wendy W Wong  2 , Saba Motakef  2 , Tyler G Frew  2 , Insiyah Campwala  2 , Subhas C Gupta  2
Affiliations

Endoscopic Brow Lift Fixation With Mitek Suture Anchors: A 9-Year Experience of a New "Ideal" Technique

Oluwaseun A Adetayo et al. Plast Surg (Oakv). 2019 May.

Abstract
in English, French

Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Objectifs: Ces dernières années, la technique endoscopique est devenue une approche peu invasive du rajeunissement du front, mais la nécessité et le moyen de fixer les sourcils font l’objet de vifs débats. Le dispositif de fixation idéal doit être non palpable, durable et demeurer en place sans devoir être retiré. Il doit également assurer le rajustement intraopératoire précis de la symétrie et de la correction de la ptose des sourcils.

Méthodologie: Les auteurs décrivent une technique de redrapage endoscopique des sourcils à l’aide de l’ancre osseuse absorbable Mitek Microfix. Ils ont procédé à une analyse rétrospective des dossiers des patients qui avaient subi un redrapage endoscopique des sourcils à l’aide de cette méthode de fixation dans un cabinet universitaire. Ils ont évalué la durée de l’opération, le taux de réopérations, la palpabilité, la permanence du dispositif de fixation, les comparaisons des coûts différentiels par rapport aux méthodes traditionnelles, l’efficacité et la courbe d’apprentissage technique. Ils ont également évalué le taux de complications et examiné l’analyse des coûts différentiels des méthodes de fixation.

Résultats: Sur une période de neuf ans (de 2005 à 2014), 82 patients ont subi une seule intervention de fixation endoscopique des sourcils à l’aide de l’ancre Mitek. L’opération durait 100 minutes en moyenne. Il n’y a eu aucun cas de palpabilité de l’implant, d’alopécie ou d’autres complications postopératoires. Deux patients ont subi un redrapage secondaire après une ptose temporale au bout d’une période moyenne de 5,5 mois.

Conclusion: L’ancre Mitek Microfix QuickAnchor procure une fixation durable sans palpabilité du dispositif. La simplicité de la technique est démontrée par le temps moyen raisonnable de l’opération obtenu avec la participation active de résidents en chirurgie. Ce dispositif à demeure est facile à utiliser pour l’opérateur et procure une fixation durable sans apparition de palpabilité ou d’alopécie.

Keywords: Mitek suture anchor; brow fixation; brow lift; endoscopic brow lift.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Preoperative incision markings. Anterior incisions are highlighted in green, posterior incisions in red, and camera port in blue.
Figure 2.
Figure 2.
Placement of the Mitek Microfix QuickAnchor into the previously drilled hole in the outer table of the cranial bone is demonstrated in the upper left photograph. A tendon passer is placed from the anterior incision to the corresponding posterior incision (upper right). One of the needles of the Mitek Microfix is captured in the tendon passer and pulled out to exit from the anterior incision. The periosteum and subcutaneous tissue sutured and the needle passed back to the posterior incision (lower left). The same procedure is repeated for the contralateral side. Both anchors are retracted and symmetry of the eyebrows are adjusted (lower right) prior to securing sutures in place.
Figure 3.
Figure 3.
A 55-year-old female presented with static transverse forehead rhytids and asymmetric bilateral brow ptosis. She underwent an endoscopic brow lift with the Mitek Microfix QuickAnchor implant-based technique. Her preoperative presentation (left) and 9-month postoperative result (right) are shown.
Figure 4.
Figure 4.
Forehead lifts performed by ASPS and ASAPS plastic surgeons from 1997 to 2013. ASPS indicates American Society of Plastic Surgeons; ASAPS, The American Society for Aesthetic Plastic Surgery.
See this image and copyright information in PMC

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