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PubMedDate not supplied

Forehead lift: a combined approach using subperiosteal and subgaleal dissection planes.

The eyelid-eyebrow region is the center for facial expression. Youth and beauty are associated with smooth, wrinkle-free skin and proportional facial features. The position of the eyebrows conveys emotion, and consequently, even a minor change in brow position can alter the expression of an individual's face. Repositioning the eyebrows and reducing the prominence of the glabellar frown lines can change the expression from one of anger and hostility to one that is more pleasant and natural. Various methods have been used for rejuvenation of the upper face. The height or length of the forehead is a useful guide for choosing the appropriate technique. We performed the coronal browlift using the subgaleal dissection plane, with subperiosteal dissection of 2.5 cm of the periosteal band over the supraorbital rim. We believe that this technique provided us with the benefits of the two dissection planes, with a more permanent result.

Adult↗
PubMed2002

Reconstruction of facial defects with superficial temporal artery island flaps: a donor site with various alternatives.

Color and texture match is crucial in reconstruction of facial tissue defects. Between March of 1997 and July of 2000, island flaps based on the parietal, anterofrontal, centrofrontal, posterofrontal, and superior auricular branches of the superficial temporal artery were used in the reconstruction of tissue defects localized on different regions of the face in 28 patients. According to the size and the location of the defect, the flap was selected. There were 15 male patients and 13 female patients, with ages ranging between 19 and 74 years. In six of the flaps, venous congestion was observed. Because of the elevation of the eyebrow on the flap side, three patients required a sling to the opposite eyebrow. Excellent color and tissue match and transfer of hair-bearing tissue to the eyebrow and beard areas were achieved with no other complications. Satisfactory aesthetic results were gained.

Adult↗
PubMed2002

Endoscopic forehead lift: review of technique, cases, and complications.

Endoscopy has provided a significant improvement in the surgical rejuvenation of the upper face. It offers a minimally invasive alternative that avoids many of the undesirable effects associated with the coronal approach. The standard minimal access forehead endoscopic procedure consists of a subperiosteal undermining through three small triangular prehairline incisions. To successfully elevate the eyebrows, it is essential to release the periosteum at the level of the supraorbital rims and ablate the brow depressor muscles of the glabella. Until the periosteum reattaches itself, elevation is maintained by a temporary suspension suture between staples at the incision sites and 5 cm posterior to the hairline. The transverse closure of the triangular skin incisions achieves some additional elevation. The biplanar approach adds a partial subcutaneous undermining of the forehead to the endoscopic technique and allows plication of the frontalis muscle and excision of excess forehead skin. It is offered to patients with very ptotic eyebrows, deep transverse wrinkles, or a high forehead. The prehairline incision is a disadvantage but is tolerated quite well in older patients. The medical records of 393 consecutive patients who underwent endoscopic forehead lift from 1994 to 2000 were reviewed. Because seven patients had the endoscopic forehead lift repeated, the number of forehead endoscopies totaled 400. The complication rate was quite acceptable and did not markedly increase when a forehead lift was performed in combination with other facial procedures. The endoscopic forehead lift consistently attenuated the transverse forehead wrinkles, reduced the glabellar frown lines, and raised the eyebrows. It provided an appearance that was less tired and angry in addition to opening the area around the eyes. Long-term follow-up has shown that the endoscopic forehead lift produces lasting and predictable results.

Adolescent↗
PubMed2004

Extended upper blepharoplasty for lateral hooding of the upper eyelid using a scalpel-shaped excision: a 13-year experience.

Excess skin of the upper lids is often accompanied by lateral overlap of skin with crow's feet because of the absence of fixation to the tarsal plate, giving the eye a sad, heavy look that often disturbs the lateral visual field. The accepted crescent-shaped blepharoplasty is somewhat convex, which is widest at the center of the lid with or without a lateral extension. However, in patients who have normal brow position or minimal eyebrow ptosis and whose main concern is the excess upper eyelid skin and lateral hooding, such a crescent excision may not suffice. A scalpel-shaped excision that is widest laterally and that tapers to a point medially will extirpate the maximal skin where it is most needed and overcome the skin excess in the lateral aspect of the upper lid. Between 1990 and 2002, 301 white patients (275 women and 26 men) between the ages of 33 and 79 years were operated on using the extended scalpel-shaped upper blepharoplasty technique. The follow-up period was more than 1 year. The lower margin of the incision is along the supratarsal crease, about 10 mm above the ciliary line. It begins medially about 1 cm above and lateral to the medial canthus. Above the lateral canthus, the skin marking is gently curved upward and outward, often within a natural skin crease or crow's feet to reach a little below and slightly beyond the lateral extremity of the eyebrow. The upper border of the incision joins the two extremities of the skin outline in a gentle convex curve. The general outline of the incision takes on the shape of a number 20 scalpel blade in which the maximal width is located laterally. Following excision of the excess skin and removal of protuberant fat pads if needed, suturing is executed from lateral to medial. The final suture line is in the form of an oblique flattened lazy S. Following the removal of the stitches on the fifth postoperative day, no wound dehiscence was noticed at the lateral scar zone. In the older individuals, due to the lax skin, the scar becomes scarcely noticeable with time and often falls within a pre-existent crow's feet crease. Elimination of some of the crow's feet was also demonstrated. In patients with visual field impairment, significant functional and visual improvement was achieved. Most patients mentioned a pleasing postoperative open "Oriental" look of the eyes. The extended scalpel-shaped upper blepharoplasty adequately deals with the hooding of the skin laterally. This technique overcomes the excess of skin in both vertical and horizontal directions, since in suturing the lateral part of the skin defect in an oblique plane, slack skin is taken up transversely, and the technique provides some indirect upward support to the lateral eyebrow. In the absence of crow's feet in the younger person, this technique is not recommended because the lateral part of this suture line is visible, especially if the scar widens.

Adult↗
PubMed2004

Morphometric relationships between tooth and face shapes.

The shape of a patient's face is commonly used as a reference to select the shape of the maxillary central incisors in edentulous patients. The validity of this relationship has not been proved. The objective of this clinical study was to determine whether a relationship exists between maxillary central incisors and face shapes. Casts were made of the maxillas of 50 men and 50 women. A standardized digital photographic procedure was used to record frontal views of each subject's face and of the maxillary central incisors of the dental casts. The shapes of the maxillary central incisors were compared with the face forms. Shape matches were evaluated according to their Hausdorff distance (HDD). The function h(A,B) is called the directed HDD from shape A to shape B (this function is not a true distance). It reflects the distance of the point of shape A that is farthest from any point of shape B and vice versa. The similarity of both shapes is given as a non-negative number. The value 0.0 indicates that the figures are identical (after scaling and shifting). Higher values indicate that shapes differ more substantially. Significant differences on the 5% level were calculated using the non-parametric Mann-Whitney U and Kruskal-Wallis tests. The face shape from the chin margin to the eyebrow line (superior edges of the eyebrows) produced a better match than the one from the chin to the hairline (P < 0.0001). On average, the maxillary central incisors displayed a variability (0.084 +/- 0.028) that was higher by a factor of 1.9 than the face shapes (chin margin to the eyebrow line, 0.045 +/- 0.015). In the interindividual comparison, the shapes of the maxillary central incisors of women displayed a significantly smaller HDD than the ones of the men (P < 0.0001).

Adolescent↗
PubMed1995

Endoscopic surgical correction of glabellar creases.

BACKGROUND: A number of alternatives exist for the temporary correction of glabellar creases and frown lines. The traditional "open" operative procedure has often involved a large incision to gain access to the depressor muscles that are responsible for the deformity. While useful for patients with multiple or more significant deformities, patients with isolated glabellar creases and frown lines have been reluctant to consider an extensive surgical procedure, with its attendant morbidity, for an isolated problem. OBJECTIVE: The purpose of this report is to describe a new technique of endoscopic corrugator muscle resection, without the need for the traditional lengthy scalp incision. METHODS: Traditional criteria for patient selection was employed. A series of 10 consecutive patients with vertical mid-forehead glabellar-eyebrow frown lines were treated by endoscopic corrugator muscle resection and evaluated. RESULTS: The procedure was efficacious in reducing the frown-muscle complex prominence and rhytids in the mid-forehead area. Circumstances of heavy folds, hyperactive muscle function, or premature furrows in patients with good skin tone appear to be most suitable for this technique. CONCLUSION: With the introduction of a more acceptable, less problematic surgical solution, deformities in the forehead-eyebrow area can be readily addressed surgically. The procedure is a cost-effective alternative to temporary techniques improving aesthetic problems in the forehead-eyebrow area.

Adult↗
PubMed1994

Intrafascicular recordings of afferent multi-unit activity from the human supraorbital nerve.

Intrafascicular recordings of afferent multi-unit activity were obtained from the supraorbital nerve in 40 healthy human volunteers, using tungsten micro-electrodes inserted percutaneously at the eyebrow. Seventy-seven fascicular receptive fields were mapped; their area ranged from 2 to 76 cm2, with a median of 19 cm2. The smallest fields were found in the eyebrow region, and the largest on the scalp. In response to non-painful electrical intradermal stimulation, the conduction velocity of the fastest nerve fibres was calculated to be 40 +/- 2 m s-1 (mean +/- SEM), and the later part of the afferent volley corresponded to a velocity of 20 +/- 1 m s-1. The responses to skin indentation indicated that the density of mechanoreceptive innervation was higher in the lower part of the forehead than in the upper/posterior part of the innervation territory of the nerve. A rapid mechanical tap on the forehead and scalp evoked two major afferent volleys corresponding to the on- and off-phase of the stimulus. Manipulation of hairs resulted not only in dynamic responses to hair movement, but also in a static discharge during sustained hair displacement. When a fascicular field included the eyebrow region, skin stretching during blinking movements evoked distinct afferent activity. Following mechanical and electrical stimuli there were no signs of 'trigeminal antidromic potentials' of the type described in the cat and monkey.

Adult↗
PubMed2005

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.

Adult↗
PubMed1983

[Treatment of nasal saddle-back deformities using a median naso-frontal five-point star flap].

Severe saddle-back deformities of the nose require reconstructive surgery using bone grafts, often in association with tegmental tissue when the point of the nose is retracted. To diminish the inconveniences of the multiple techniques proposed, the procedure employed involves the use of a mesiofrontal, inter-eyebrow sliding graft with its superior point in VY, and with a pedicle consisting of the remaining tissue of the nasal ridge. Four triangular flaps arise from the edges of this flap, their apices being external and supra- or infra-eyebrow in position. They are transposed downwards for one stage, into two infra-eyebrow and infra-canthal zones. These will fill the raw surfaces to allow the bone graft to be applied. Loss of frontal substance is compensated by a VY above and by apposition of the edges laterally. The lateral flaps replace the two peri-orbital losses of substance, and give a sufficient amount of tissue on either side of the nasal ridge to enable the bone graft to be covered without excessive tension. This technique presents the advantages of being performed as a one-stage operation and of producing less scarring. The flap has the shape of a star with five branches and is termed a christmas tree flap; the pedicle is situated below and forms the roots of the tree.

Humans↗
PubMed1995

[Palpebral measurements in healthy subjects in Zaire].

PURPOSE: It is to establish the age norms of upper eyelid in the black subjects. METHOD: Measurements of upper eyelid, eyebrow height, crease height and the palpebral fissure were performed on 174 healthy Zairian subjects, without facial abnormalities. The subjects age-ranged from 1 to 60 years. There were 73 males (mean age +/- SD, 25.8 years +/- 15.6) and 101 females (mean age +/- SD, 24.8 years +/- 13.4). No statistically significant difference was found between the two sexes for mean age. Subjects were divided into five age groups: the first age group included subjects aged from 1 to 10 years, the second age group included subjects aged from 11 to 20 years, the third age group included subjects aged from 21 to 30 years, the fourth age group included subjects aged from 31 to 40 years, the fifth age group included subjects aged from 41 to 60 years. The measurements were performed with a ruler. RESULTS: The mean eyebrow height measurements varied from 10.72 (group I) to 11.87 mm (group V) for the right eye, and from 10.76 mm (group I) to 11.74 mm (group V) for the left eye. Average pretarsal skin height ranged from 3.17 mm (group I) to 3.17 mm (group V) for the right eye and from 3.24 mm (group I) to 3.00 mm (group V) for the left eye. Average crease height measurements varied from 5.54 mm (group I) to 6.48 mm (group V) for the right eye, and from 5.57 mm (group I) to 6.78 mm (group V) for the left eye. The average palpebral fissure varied from 8.97 mm (group I) to 9.83 mm (group V) for the right eye and from 8.86 mm (group I) to 10.00 mm (group V) for the left eye. All measurements were aged related (p < 0.05). CONCLUSION: Our results of upper eyelid crease height, eyebrow height, the amount of visible pretarsal skin and the amount of the palpebral fissure showed higher values than those published recently for caucasian subjects. The data obtained in this study showed racial difference and must be taken into account in interpretations of palpebral diseases and cosmetic surgery of the eyelid.

Adolescent↗
PubMed1994

[Anatomy of the superficial parts of the face and neck].

The author presents four chapters concerning classical anatomy, an anatomical contribution to new facelifts, aesthetic anatomy, which recalls the aesthetic relations of the face, and finally a brief review of the mode of ageing of the face. The embryology of the superficial plane of the face and neck shows that the development of muscles of facial expression, deep and superficial fatty tissues, the facial nerve and the parotid is the result of divergent migratory movements and confluences. The anatomy is discussed in two parts: the first concerns conventional anatomy, and reviews the anatomical data acquired to date, the second proposes anatomical conclusions adapted to new surgical techniques of rejuvenation. The branches of the facial nerve are unusual in terms of their great variability. However, by using anatomical landmarks, it is possible to localize them precisely. The blood supply of the superficial tissues of the face and neck has been the subject of many studies. Deep monoblock facelifts, by sparing the blood supply of certain anatomical planes, allow the perfectly safe creation of extensive skin flaps. Some muscles of the face and neck are useful surgically. The orbicularis oculi muscle is also a muscle of the orbital margins by its depressing action on the eyebrows and levator action on the superficial malar adipose tissue. The corrugator muscle is a central element of new frontal endoscopy techniques. Elevation of the eyebrows is then ensured by the occipitofrontal complex which occupies only the medial two-thirds of the eyebrows. The zygomaticus major muscle must be released over its entire length because excessive traction on a SMAS flap can induce a disorder of facial expression. The platysma muscle plays an increasingly important role in cervical surgery and constitutes the deep guarantee of the cervical corset. The four fixed osteocutaneous points of the face: zygomatic (Mac Gregor), mandibular (Furnas), orbital (Psillakis) and masseteric play an antigravitational and functional role in facial expression. A macroscopic anatomical and histological study, performed on 60 dissections of hemifaces with several preparations defined the anatomy of the superficial musculoaponeurotic system (SMAS), jugomalar adipose planes and the nasolabial fold. The SMAS is a strictly superficial surgical anatomy structure derived from the primitive platysma muscle, and does not possess any bony insertion. It is composed exclusively of platysma and risorius muscles. There is no parotid aponeurosis. The parotid is surrounded by a capsule. Its is limited in depth by the superficial cervical aponeurosis which lines the styloid curtain (Jost, Levet).(ABSTRACT TRUNCATED AT 400 WORDS)

Esthetics↗
PubMed1983

Episcleral and orbital pseudorheumatoid nodules.

Pseudorheumatoid nodules are subcutaneous necrobiotic granulomas that are histopathologically similar or identical to those seen with rheumatoid arthritis, granuloma annulare, necrobiosis lipoidica diabeticorum, and systemic lupus erythematosus. Although these nodules are most common in children, they are also seen in adults and are usually located on the extremities and scalp. Eyelid and eyebrow involvement is seen infrequently. We histopathologically verified episcleral and orbital pseudorheumatoid nodules in an adult with eyelid and eyebrow nodules. Pseudorheumatoid nodules must be included in the differential diagnosis of subconjunctival mass lesions that may concomitantly involve the orbit, episclera, and periocular region.

Adult↗
PubMed1978

The brow-lift operation in a man.

Various techniques of brow elevation, including their advantages and limitations, are discussed. Since there are no lines immediately above the eyebrow, the direct brow-lift operation results in a scar that cannot be camouflaged with makeup by a man. The approach via temporofrontal scalp produces limited and temporary brow elevation, and the scars may eventually become visible with hairline recession in men. A technique of the brow-lift operation in a man via the natural, horizontal forehead crease above the eyebrow has been found to be very effective. The complications have been minimal, the resulting scars have been unnoticeable.

Adult↗
PubMed2005

Compensatory brow asymmetry: anatomic study and clinical experience.

To obtain detailed information about the interdigitation between the frontalis muscle and the orbicularis oculi muscle, the authors performed an anatomic study involving 9 cadavers (17 specimens). Three types of interdigitation were recognized. Complete interdigitation was noted in 13 specimens, and partial interdigitation in 13 specimens. In one specimen, there was no interdigitation between the frontalis muscle and the orbicularis oculi muscle. Although most of the specimens showed complete interdigitation between the frontalis muscle and the orbicularis oculi muscle, the interdigitation area exhibited architectural heterogeneity. The study findings provide a basis for a better understanding of compensatory eyebrow ptosis. In addition, two cases supporting the theory that compensatory eyebrow asymmetry may resolve when the palpebral ptosis is treated are presented.

Adult↗
PubMed1996

Bilateral tuberculous abscesses on the face (eyelids) of a child.

PURPOSE: To report a rare case of tuberculosis with facial abscess. METHODS: A 4 1/2-year-old girl had an acute left upper eyelid abscess and a large, spherical tumescence involving the right upper eyelid, eyebrow, and forehead. The left upper eyelid abscess was drained, and the mass involving the right eyelid, eyebrow, and forehead was excised. RESULTS: Histopathologic and microbiologic examination established a human type of tuberculous mycobacterium as the cause of the bilateral facial lesions. CONCLUSION: Tuberculosis should be considered as a possible cause of abscess even when clinical features are not typical.

Abscess↗
PubMed1979

Ocular asymmetry measuring device.

An instrument that measures ocular, eyebrow, canthal, and lower eyelid asymmetries accurately is useful for evaluating various deformities before oculoplastic surgery is performed. The ocular asymmetry measuring device comprises a headband, a ruler, and a T-shaped crosspiece. When the band is placed around the patient's head at forehead level, it fixes the ruler vertically over the midforehead. The metal rod is aligned with whatever eyelid, eyebrow, eye, or canthus is lower and is then elevated until it transects a similar structure on the opposite side. The degree of asymmetry is measured in millimeters. The device is useful in determining the degree of correction needed in various conditions that result from orbital fracture, facial paralysis, and congenital anomalies.

Eye Abnormalities↗
PubMed1999

Surgical rejuvenation of the brow and forehead.

The position and orientation of eyebrows plays an important part in the overall appearance of the face. Many incisions and approaches have been described to elevate a ptotic eyebrow. It is essential to understand the periorbital anatomy and the biomechanics of elevation and fixation of the brow and forehead soft tissues. If properly planned and executed, surgical brow lifts can restore a youthful appearance to eyelids and the orbit.

Biomechanical Phenomena↗
PubMed1995

Judgment of gender through facial parts.

Japanese male and female undergraduate students judged the gender of a variety of facial images. These images were combinations of the following facial parts: eyebrows, eyes, nose, mouth, and the face outline (cheek and chin). These parts were extracted from averaged facial images of Japanese males and females aged 18 and 19 years by means of the Facial Image Processing System. The results suggested that, in identifying gender, subjects performed identification on the basis of the eyebrows and the face outline, and both males and females were more likely to identify the faces as those of their own gender. The results are discussed in relation to previous studies, with particular attention paid to the matter of race differences.

Adolescent↗