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PubMed2004

Subperiosteal brow lifts without fixation.

Most surgeons today advocate an endoscopic subperiosteal brow lift for surgical correction of the upper third of the face. At the author's clinic, this operation has been performed since 1994 and the subgaleal bicoronal brow lift is no longer used. In earlier investigations, the author showed that the subperiosteal approach (n = 60) gives a better result than the subgaleal method (n = 60) when compared 1 year after surgery. In the literature, however, there are no published data regarding the long-term results of subperiosteal brow lifts. The author took material from his earlier investigations and looked at the same patients 5 years postoperatively. He compared the subperiosteal approach (n = 30) with the subgaleal brow lift (n = 15) and found that after 5 years the brows of the subgaleal patients were on the same level as they were before surgery, but in the group of subperiosteal brow lifts, almost all of the brows were higher 5 years after surgery than they were 1 year after surgery, with a mean increase in height of 2.5 mm. These findings led the author to the question whether scalp fixation was necessary at all when performing a subperiosteal brow lift. He performed 20 subperiosteal endoscopic brow lifts where scalp fixation was not used at all, relying only on changing the balance of muscle vectors around the eyebrows. Using a computerized instrument, measurements were made of the distance between the medial canthus and the top of the eyebrow, the midpupil and the top of the eyebrow, and the lateral canthus and the top of the eyebrow. All patients were measured before and 1 year after surgery. The author found an increase of the vertical height from the midpupil to the top of the brow, with an average increase of 3.9 mm. There were no differences between patients who had only a brow lift and those who had a brow lift and an upper blepharoplasty at the same time. The author concludes that for most cases where an increased vertical height of the brows of more than 4 mm is not needed, it is not necessary to use scalp fixation to achieve a natural result.

Adult↗

PubMed1998

Mouse bioassay versus Western blot assay for botulinum toxin antibodies: correlation with clinical response.

OBJECTIVE: To compare the mouse protection bioassay (MPB) to the Western blot assay (WBA) in detecting antibodies against botulinum toxin A (BTX-A) and to correlate the assay results with clinical responses to BTX-A injections. METHODS: MPB and WBA assay results were compared in 51 patients (34 nonresponders and 17 responders) who received BTX-A injections, most commonly for cervical dystonia. A subset of patients received a "test" injection into either the right eyebrow (14) or right frontalis (12). RESULTS: Twelve patients with antibodies against BTX-A (Ab+) detected by WBA did not demonstrate antibodies (Ab-) by MPB. Conversely, five patients were Ab+ by MPB but Ab- by WBA. Specificity of the MPB was 100% on all three parameters (clinical, eyebrow, and frontalis injections), whereas WBA specificity was only 71% for clinical response but 100% for both eyebrow and frontalis responses. Sensitivities for both assays were low (33 to 53%). Of the 16 patients previously Ab+ by MPB, seven became negative on retesting after a mean interval of 33 months (range, 6 to 93 months). CONCLUSIONS: The lower specificity of the WBA compared to the MPB suggests that the WBA detects nonblocking antibodies. Eyebrow and frontalis "test" injections correlated well with MPB and WBA results and with clinical responses and may be useful in the evaluation of BTX nonresponders.

Adult↗

PubMed1983

Current concepts of browpexy.

The excess skin of the upper lid is not uncommonly secondary to the ptosis of the eyebrows. Blepharoplasty not only fails to correct this deformity but, in fact, may aggravate the sagging of the eyebrow, imparting a sad and elderly appearance to the face. A gracefully arching eyebrow at or slightly above the supraorbital rim renders the face more alert and beautiful. Of many procedures described, three browpexy techniques have withstood the test of time, each with its own set of advantages and limitations: (1) direct, (2) midforehead, and (3) frontal lift. Particular emphasis is given to the coronal-type forehead lift which, in addition to browpexy, can deal with the ptosis of the forehead, transverse forehead wrinkles, and glabellar rhytids.

Blepharoptosis↗

PubMed1993

Brachmann-de Lange syndrome. Delineation of the clinical phenotype.

A total of 31 cases previously diagnosed as having Brachmann-de Lange syndrome were ascertained and examined, of which 11 were thought to have been misdiagnosed. Of those correctly diagnosed, there appeared to be a phenotypic dichotomy with classical and mild cases. Those facial findings of greatest diagnostic value were the combination of the characteristic eyebrows, long philtrum, thin lips and crescent-shaped mouth. The characteristic eyebrows were neat, well defined and arched as though they had been pencilled. This combination of anomalies was absent in postpubertal males but not in postpubertal females. Facial abnormalities most likely to lead to incorrect use of the eponym were hypertrichosis, synophrys, and bushy eyebrows.

Adolescent↗

PubMed1993

Total scalp replantation based on one artery and one vein.

A successful replantation of a totally avulsed scalp, including both eyebrows, with only one arterial and one venous anastomosis to the superficial temporal vessels is described. Apart from a small partial skin necrosis of the right eyebrow, the entire transplant survived. Subsequently, the patient required only minor additional skin grafting, correction of scars with a skin expander, and reconstruction of the eyebrow with hair micrografts. Replantation of the total scalp based on two or more vessels has previously been recommended and reported elsewhere. In the present case, complete survival of the scalp on only one artery and one vein was demonstrated, indicating that replantation should be considered even if available vessels for anastomosis are minimal.

Adult↗

PubMed1987

Facial mimics and the coronal brow lift.

The classic rhytidectomy leaves the upper third of the face without improvement. Yet the eye-eyebrow region is the most influential in determining facial expressions. There is only a narrow range of positions of the eyebrows in which they are perceived as attractive. The influence of the coronal browlift on facial mimics is discussed as it seems to be a way to predictably reposition the eyebrows and improve crow's feet and forehead, and glabellar wrinkles at the same time. The results of 56 patients surveyed 1-3 years postoperatively are presented.

Eyebrows↗

PubMed2005

[Indication, technique and clinical out come of the endoscopic assisted forehead and brow lift].

AIMS: The aim of this study was to determine the indication for endoscopic-assisted forehead and brow lift and to present the surgical technique and evaluate clinical outcome. PATIENTS AND METHODS: A total of 61 female patients between 36 and 64 years (s=49.64) were operated from 1999 through 2002 with the endoscopic-assisted forehead and brow lift and were observed pre- and postoperatively and 6 months after surgery. The galea aponeurotic flap was fixed through a bone tunnel (tabula externa) with nonabsorbable sutures in all patients. We measured the distance between the middle of the pupil and the most cranial point of the eyebrow as well as the largest distance between the eyebrow and the hairline intraoperatively and 6 months after surgery. The patients' satisfaction with the outcome of these surgical procedures was determined on a scale from 1 to 10 with 1 as the worst and 10 as the best mark. RESULTS: We found a brow lift of 8.03 mm (s=1.622) on average. The endoscopic forehead and brow lift was indicated up to the maximal distance of 12 cm between the eyebrow and the hairline. The patients' satisfaction with the outcome was registered on average at 6.98 (s=1.36) on our scale. A temporary unilateral weakness of the frontal branch of the facial nerve was the severest complication found postoperatively. CONCLUSION: The endoscopic-assisted forehead and brow lift is a safe and effective method to improve upper face aesthetics. A high grade of patient satisfaction is obtainable. The advantage in using this method is the invisible scar formation. The indication is limited by a high hairline.

Adult↗

PubMed2004

[The retro-orbicularis oculus fat (ROOF) or Charpy's fat pad. Descriptive and functional anatomy. Surgical concepts applied to the design of a frontotemporal lift procedure].

The eyebrow fat pad, or retro-orbicularis oculus fat (ROOF) is a syssarcosis, described as an anatomic and functional unity by M. Charpy in 1909. Our anatomic study on 12 (24 half-head) fresh cadaver specimens confirm anatomic variations, mainly according to age and sex. Synthesis of recent literature shows the renewed interest for this fat pad and its involvement in the eye's lateral flare. We will describe its detailed ultrastructure and the physiopathological mechanisms of aging, causing an earlier lateral eyebrow ptosis. So we can evolve new anatomic concepts applied to recent facial rejuvenative procedures, particularly frontotemporal facelifts (endoscopic or classical procedures), by a harmonious repositioning of the eyebrow and in order to restore the lateral flare of the eye.

Adipose Tissue↗

PubMed2005

Frontal fibrosing alopecia in postmenopausal women.

BACKGROUND: Frontal fibrosing alopecia is a variety of cicatricial alopecia characterized by a band of frontal/frontoparietal hair recession and marked decrease or a complete loss of the eyebrows, typically observed in women who are postmenopausal. OBJECTIVE: The purpose of this study was to report clinical and histopathologic findings and results of treatment in a group of women affected by the disease. METHOD: A total of 14 women with alopecia of the frontal hairline were evaluated from June 2000 through July 2003 in our outpatient consultation for hair disorders. RESULTS: Clinical examination revealed a band of symmetric recession of the frontoparietal hairline extending to the preauricular areas associated with loss of follicular orifices, mild skin atrophy, and perifollicular erythema at the scalp margin. In all, 9 patients also had partial or total loss of the eyebrows. The histologic features of the scalp specimens were similar in all our patients with a reduction of the number of hair follicles, and a high number of intermediate and velluslike follicles. Intemediate and velluslike follicles were more commonly affected than terminal follicles by the lymphocytic inflammatory infiltrate and perifollicular fibrosis. CONCLUSION: Frontal fibrosing alopecia is a cicatricial alopecia that follows destruction of hair follicles by an inflammatory lymphocytic infiltrate that is localized around the upper portion of the hair follicle. It differs from lichen planopilaris because the lymphocytic infiltrate and fibrosis affect selectively the intermediate and the velluslike follicles of the frontal margin and eyebrows. The reason for this selective involvement is still unknown. Frontal fibrosing alopecia may represent a variety of lichen planopilaris with selective involvement of certain androgen-dependent areas. The affected follicles may have typical biologic markers that could explain the clinical and histologic features found in the disease. It is interesting to note that some of the patients treated with finasteride (2.5 mg/d) showed an arrest in the progression of the disease. Even if there is no proof for a hormonal basis of the disease, the effectiveness of finasteride in some patients may indicate that androgens might be partially responsible of the pathogenesis of the disease.

Aged↗

PubMed1997

Postmenopausal frontal fibrosing alopecia: a frontal variant of lichen planopilaris.

BACKGROUND: Lichen planopilaris usually produces multifocal areas of scarring alopecia. Recently, a condition in postmenopausal women characterized by progressive frontal hairline recession associated with scarring has been described. OBJECTIVE: Our purpose was to study the clinical and histopathologic features and results of treatment in a group of women with the frontal variant of lichen planopilaris and to compare the immunohistochemical profile of scalp biopsy specimens from this subset with that found in the multifocal variant of lichen planopilaris. METHOD: The clinical data as well as the histopathologic findings in 16 women with frontal fibrosing alopecia were collated. The immunohistochemical profile of six scalp biopsy specimens from the frontal hairline were compared with six specimens from women with multifocal lichen planopilaris. RESULTS: In addition to the progressive frontal fibrosing alopecia in all 16 women, total loss or a marked decrease of the eyebrows was observed in 13. No evidence of lichen planus was observed at other sites. In one patient multifocal areas of lichen planopilaris developed in the scalp. The frontal fibrosing alopecia was slowly progressive but has stabilized in five patients. Biopsy specimens from the frontal hairline showed histologic changes identical to lichen planopilaris. Immunophenotyping failed to reveal any significant differences between the frontal and multifocal variants. No effective treatments emerged although oral steroids and antimalarials may temporarily slow the course. Hormone replacement therapy did not appear to influence the course of the alopecia. CONCLUSION: Progressive frontal fibrosing alopecia is a clinically distinct variant of lichen planopilaris that affects in particular elderly women and frequently involves the eyebrows. The basis for this lichenoid tissue reaction targeting frontal scalp follicles and eyebrows is unknown.

Administration, Oral↗

PubMed2005

[The anatomy of the surgical treatment of migraine].

OBJECTIVE: The transpalpebral resection of the corrugator and depressor supercilii muscles is a new treatment option for migraine headaches. Hyperactive contractility of these muscles can provoke the peripheral compression of the supratrochlear nerve and induce a neurogenic inflammation triggering the symptoms of migraine. In order to gather detailed knowledge of the respective anatomy in the eyebrow region, a macroscopic cadaver study was conducted. MATERIALS AND METHODS: The relevant muscles of the forehead, glabella and eyebrow were dissected in five fresh, non-preserved heads. The supracanthal origins and dermal points of insertion were marked. Following the preparation of the neurovascular structures, the muscles were measured and weighed. The course of the supraorbital and supratrochlear nerves was demonstrated from the forehead to the orbital cavity. RESULTS: There are three, paired groups of muscles in the superomedial region of the orbital rim. They can be divided into the superficial frontalis and procerus muscle, the orbicularis muscle in a middle layer and the corrugator and depressor supercilii in a deeper layer. The corrugator measured approximately 4.5 cm, whose origin is superior and posterior to the depressor origin situated cranial to the medial canthus. The corrugator inserts lateral to the exit of the supraorbital nerve in the dermis above the eyebrow after penetrating the orbicularis and frontalis muscles and a subgaleal fat pad. The length and weight of the muscles is highly variable. The muscle is penetrated by the supratrochlear nerve whereas the supraorbital nerve runs underneath it. The corrugator is innervated medially and laterally by branches of the facial nerve. CONCLUSION: A detailed knowledge of the complex arrangement of the muscles acting upon the glabella and the different communicating subgaleal and preseptal fat pads allow the identification and resection of the corrugator and depressor muscles without damaging the supratrochlear nerve. The course of the specific nerves is variable. The double-innervation of the corrugator suggests its complete resection instead of the selective denervation of the muscle.

Cadaver↗

PubMed1999

Hair ignition by dye laser for port-wine stain: risk factors evaluated.

Flashlamp-pumped pulsed dye laser is the preferred treatment for port-wine stain. Vascular hemoglobin and epidermal melanin are competing sites for dye laser absorption and damage. The case presented illustrates the potential hazard of ignition induced by dye laser treatment on the face of a patient receiving inhalation anesthesia. A 6-year-old girl with almost black hair was treated for a port-wine stain covering most of the right half of her face. She was treated with dye laser under general anesthesia administered by mask. A laser pulse close to the upper part of the eyebrow induced a blaze and the eyebrow was instantly destroyed by the fire. Regrowth of the eyebrow was complete after a few months. Hair specimens of various colors were exposed experimentally to dye laser irradiation in room and oxygen-saturated atmospheres. Risk factors of ignition are high laser dosage, a high oxygen level, repeated pulses and dark colored hair.

Child↗

PubMed2003

A simple modification of the glabellar flap in medial canthal reconstruction.

PURPOSE: To highlight a simple modification of the traditional glabellar flap, which may improve the cosmetic results achieved with this flap by reducing the tendency for the eyebrows to be drawn together. METHODS: The modified surgical technique is described and used prospectively in 10 patients requiring medial canthal reconstruction with a glabellar flap. RESULTS: All patients were satisfied with the cosmetic and functional results. Photographs of one patient illustrate the preoperative and postoperative appearance of the eyebrows. CONCLUSIONS: This simple modification is recommended to avoid drawing the eyebrows together when using the glabellar flap.

Aged↗

PubMed2006

Endoscopic forehead rejuvenation: I. Limitations, flaws, and rewards.

BACKGROUND: The efficacy of endoscopic forehead rejuvenation has been questioned. However, many proponents of the technique are convinced that this procedure is indeed an optimal choice for the majority of patients desiring forehead rejuvenation and have found the means of preventing adversities. METHODS: The purpose of this article is to discuss the common features and reasons for suboptimal endoscopic forehead rejuvenation outcomes and avoidance of these flaws based on the author's experience with 372 procedures. RESULTS: These imperfections include inadequate muscle resection, under- or overelevation of the eyebrows, asymmetry, glabellar dimpling or depression, displeasing eyebrow arch, and excessive separation of the eyebrows. CONCLUSIONS: In this report, the details of these flawed outcomes are discussed, and the ways in which they can be avoided or corrected are reviewed to improve the learning curve for less-experienced surgeons and to aid in producing more predictable and pleasing results.

Endoscopy↗

PubMed2006

Endoscopic forehead rejuvenation: II. Long-term results.

BACKGROUND: The purpose of this study was to analyze the long-term objective and subjective outcomes in patients who have undergone endoscopic forehead rejuvenation. METHODS: Preoperative and postoperative photographs of 100 patients who underwent endoscopic forehead rejuvenation by one surgeon (B.G.) between 1993 and 2001 were objectively analyzed. Postoperative changes in left and right eyebrow position were assessed in each patient by counting the number of pixels in the digitalized photographs and by clinical measurements, and compared with preoperative values. In addition, subjective ratings of the surgical outcome obtained from both the patient and the evaluating surgeon were compared. All data were analyzed using the paired t test. RESULTS: The average postoperative follow-up was 44 months (range, 12 to 95 months). Statistically significant differences in brow position between the preoperative and postoperative periods were observed in the following categories: the average distance from the lower brow margin to the upper eyelid margin (p < 0.005), the average distance from the lateral brow margin to the medial canthus horizontal line (p < 0.001), elevation of the lateral canthus relative to the medial canthus (p < 0.001), and the distance between the medial margins of the eyebrows (p < 0.001). In addition, preoperatively, 74 percent of eyebrows were positioned below the superior orbital rim, whereas 97 percent were positioned at the rim or above postoperatively, with 82 percent positioned above the rim. The most common complications were some degree of persistent paresthesia (50 percent), itching (14 percent), and forehead dynamic imperfections and irregularity (10 percent). CONCLUSION: Endoscopic forehead rejuvenation improves brow position relative to the orbital rim, brow arch form, vertical frown lines, and horizontal frown lines of the forehead, with stable results many years after surgery.

Adult↗

PubMed1999

Detection of human papillomavirus types 6 and 11 in pubic and perianal hair from patients with genital warts.

Genital human papillomavirus (HPV) types 6 and 11 are of clinical importance due to their role in the development of anogenital warts. A pilot study was performed to investigate whether DNAs from HPV types 6 and 11 are present in hairs plucked from the pubic and perianal regions and eyebrows of patients with genital warts at present and patients with a recent history of genital warts. Genital HPV DNA was detected in 9 of 25 (36%) pubic hair samples and in 11 of 22 (50%) perianal hair samples by the CPI/CPIIg PCR. After sequencing of 17 of 20 samples, HPV type 6 or 11 was detected in 6 of 25 (24%) hair samples from the pubis and 8 of 22 (36%) hair samples from the perianal region. These types were not detected in plucked eyebrow hairs. In contrast, the HPV types associated with epidermodysplasia verruciformis were detected in similar proportions (62%) in both samples of pubic and eyebrow hairs. Moreover, HPV type 6 and 11 DNAs were detected in pubic hairs plucked from two patients who had been successfully treated and who did not show any lesion at the time of hair collection; this finding is an argument that HPV DNA may persist in this region. The presence of genital HPV types in plucked pubic and perianal hair suggests that there is an endogenous reservoir for HPV which may play a role in the recurrences of genital warts.

Adult↗

PubMed1991

Criteria for the forehead lift.

We have developed clinically useful measurements to assist the surgeon in deciding when to do the forehead lift and where to place the incision. Also, we have reviewed our experience over the past decade and discuss the four categories and applications of forehead lifts. We use three indications for forehead lift: ptosis, creases, and previous facelift (PCP). There are four basic surgical techniques applicable to the upper face: (1) direct browlift, (2) midforehead crease incision, (3) prehairline incision, and (4) posthairline incision. We determined more accurate guidelines from measurements taken on 50 volunteers, as well as patients seeking a facelift. The line of measurement in a vertical plane extends from the midpupil to the top of the eyebrow and up to the hairline. We have found that the normal distance from the midpupil to the upper edge of the eyebrow on average is 2.5 cm and that the distance from the upper edge of the eyebrow to the hairline is approximately 5 cm on average. If the distance from pupil to brow is less than 2.5 cm, then the patient may benefit from a forehead lift. If the distance from brow to hairline is less than 5 cm, then we use a posthairline incision in females. If this same distance is greater than 5 cm in females, we advise the prehairline incision. In male patients we strongly consider direct crease incision. The direct browlift is reserved for minimal ptosis, asymmetry, or patients who wish a minimal procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2003

Forehead lifting: the juxtapilose subperiosteal approach.

Aging in the upper face becomes more evident as the eyebrow level descends. Sometimes this may begin at an early age. The senior author has described a limited approach for the treatment of this aesthetic alteration. In selected cases, the juxtapilose incision, placed laterally at the margin of the anterior hairline, allows for the subperiosteal undermining of the entire forehead and dissection of the elements that cause the descent of the eyebrow. The procedure is safe and expedient, and permits for a controlled repositioning of the eyebrow. In this paper, the authors describe the juxtapilose incision and the subperiosteal approach of the forehead as a practical ancillary procedure for correction of the aging face.

Aging↗