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PubMed1994

Forehead-brow rhytidoplasty: reassessing the goals.

Forehead-eyebrow rhytidoplasty traditionally has been advocated for senile brow ptosis. As the procedure became more widely accepted, it became a routine consideration in facial rejuvenation surgery. Indeed, over time, forehead-eyebrow rhytidoplasty also has withstood the initial criticism that was lodged against it of limited longevity, and it is realized that as with all other lifting procedures, it will gradually succumb to time, gravity, and the aging process. Moreover, refinements in techniques have added versatility to the procedure so that a variety of problems encountered in the upper face in addition to brow ptosis can be addressed. Consequently, an eclectic population with a range of deformities benefits from the procedure. Recently, though, it has seemed that the pendulum is swinging back, and that some surgeons are hesitating to incorporate forehead surgery because patients are voicing dissatisfaction with it. In order to assess the goals and indications for surgery, we reviewed a series of 350 patients who had a variety of aesthetic complaints in the upper face. Traditionally, patients' "other" indications for surgery, exclusive of brow ptosis, have been referred to as secondary (minor) indications. Now, with closer scrutiny, it appears that such problems, including forehead rhytids, frown muscle imbalance, upper eyelid aesthetics, lateral temporal laxity, and an abnormal expression, as a newly defined group, may actually be more frequent reasons than brow ptosis alone for performing a forehead-brow rhytidoplasty. As evaluated by the authors and supported by independent reviewers, low brow position alone should now account for less than half the forehead-brow surgery candidates. Furthermore, it is recognized that in considering the benefits achieved for patients with brow ptosis, often the results were due to "ancillary" surgical maneuvers routinely employed for the secondary indications. On balance, surgeons are advised to avoid adhering to traditional formulas for skin excision/brow elevation when operating on the brow; these can ultimately be the source of unsatisfactory outcomes. We believe that this philosophy will ultimately account for improved outcomes in forehead surgery. In addition, objective guidelines for the upper face have been reviewed and visual criteria defined which can be used in supplementing established brow spatial relationships for determining the ideal normal criteria for the upper third of the face.

Adult↗
PubMed1997

[Video-assisted endoscopic lifting: development].

Now the Endoscope is used differently in video-assisted Face-lifts. Authors describe their evolution for 2 years and a half. In the beginning. It was used to correct glabellar frowns. Then, the endoscope served to elevate the forehead by a subperiosteal approach. Sometime it was combined with a subperiosteal malar dissection in an Endoscopic full face-lift. Bad results on the eyebrows and eyelids complications involved the authors to modify their strategy: By changing the dynamic of muscles: lateral section of the orbicularis occuli muscle arises the frontal muscle to definitely lift up the eyebrow: this is called the "myotomy box"; by preferring a subgaleal, retro-orbicularis dissection, under the malar fat pad and the platysma muscle in a deep plane but always above the zygomaticus major muscle, protector of the facial nerve in the buccal space; by developing new endodissectors efficient and less aggressive to spread the deep planes without damage; by an acute control of the fronto-temporal and cervico-facial deep dissection using new endoscopic valves; by treating precise damaged areas with Limited Endoscopic Face-Lifts in a same harmonious deep dissection instead of large multiplanar underminnings.

Endoscopy↗
PubMed1997

[Subperiosteal endoscopic forehead facelifting].

The use of endoscopic techniques in facelifts has had a significant effect in recent two years. To reduce operation complications and trauma, the authors performed 31 endoscopic forehead rejuvenation procedures with corrugator-procerus resection and eyebrow elevation at a desired level in Chirurgie Esthetique Europeenne in Strasbourg, France from January to November 1995. Three to six months' follow-up revealed satisfactory operation results. Subperiosteal endoscopic forehead facelifting using resection and elevation of the muscle of the eyebrow is one of the best operations for facelifting.

Adult↗
PubMed1998

[Endoscopic fronto-temporo-malar face lift. Technique and results apropos of 18 cases].

Endoscopy was recently introduced into facial cosmetic surgery in 1992 following the work by O. Ramirez and N. Isse. Endoscopic facelift is not only a surgical approach, but also represents a new pathophysiological concept. The creation of a new balance between levators and depressors of the eyebrow allows ascension of the eyebrow and reduction of hypertonicity of the frontalis muscle, responsible for horizontal wrinkles. Based on a series of 18 patients operated at the Pitié-Salpêtrière hospital over the last 2 years, the authors describe the technique, the complications and define the indications.

Adult↗
PubMed1964

THE DE LANGE SYNDROME: REPORT OF THREE CASES.

Three cases of de Lange's syndrome are described. This condition is characterized by generally severe mental retardation, reduced stature, mild microcephaly, hypertrichosis, various anomalies of hands and feet, and a peculiar facies. The most outstanding features of the latter are the low forehead, profuse, generally confluent eyebrows, abundant long eyelashes, eyes that frequently slant downwards and outwards in antimongoloid fashion, pug nose with prominent anteverted nostrils, increased distance between nose and vermilion border of upper lip, slight reduction in size of chin, and often abnormally low-placed ears. The etiology of de Lange's syndrome is at present unknown.

Adolescent↗
PubMed1983

Keratosis follicularis spinulosa decalvans. Report of two cases and literature review.

We report herein two cases of keratosis follicularis spinulosa decalvans (KFSD) and review the literature on this condition. The entity is one of a group of related disorders that shows keratosis pilaris with inflammation followed by atrophy. The clinical features and course of KFSD are characteristic. During infancy, keratosis pilaris begins on the face and, by childhood, progresses to involve the trunk and extremities. Sometime during childhood or up to the early teenage years, a cicatricial alopecia of the scalp and eyebrows develops and is the hallmark of this disorder. Hyperkeratosis of the palms and soles is a frequently associated finding and is usually manifested during adolescence. Other features occurring with this syndrome include atopy, photophobia, and corneal abnormalities. Sex-linked inheritance has been proposed by several authors.

Adult↗
PubMed1998

Generalized atrophic benign epidermolysis bullosa in 2 siblings complicated by multiple squamous cell carcinomas.

BACKGROUND: Generalized atrophic benign epidermolysis bullosa is a form of junctional epidermolysis bullosa characterized by skin fragility; atrophic alopecia; sparse eyebrows, eyelashes, and axillary and pubic hair; dystrophic fingernails and toenails; and enamel defects in decidual and permanent teeth. Substantial progress was recently made elucidating the genetic defects underlying this disorder. In affected persons, pathogenetic mutations were identified in the genes encoding the beta 3 chain of laminin 5 (LAMB3) or the 180-kd bullous pemphigoid antigen (BPAG2/COL17A1). OBSERVATIONS: Two brothers, aged 39 and 32 years, had characteristic clinical features of generalized atrophic benign epidermolysis bullosa. By electron microscopy, dermoepidermal separation was seen at the level of the lamina lucida, establishing a diagnosis of junctional epidermolysis bullosa. Lesional and clinically unaffected skin showed basal keratinocytes with hypoplastic hemidesmosomes, possibly indicating a defect of hemidesmosomal or associated proteins. Both patients presented with multiple fungating tumors on atrophic and scarred skin on their lower legs; 2 tumors in the older sibling and 4 tumors in the younger sibling were diagnosed as well-differentiated squamous cell carcinomas. Tumor staging elicited no evidence of regional lymph node involvement or systemic disease. Treatment was by microscopically controlled surgery. All wounds were allowed to heal by secondary intention. In both patients, wound healing was markedly delayed and characterized by the formation of abundant granulation tissue and poor re-epithelialization. CONCLUSIONS: In the absence of other apparent risk factors for the development of squamous cell carcinomas, chronic wounding resulting from recurrent skin blistering probably provided an important prerequisite for tumor promotion in these patients. The 2 cases presented herein provide evidence that the development of malignant skin tumors in patients with epidermolysis bullosa is not confined to the dystrophic forms but also may occur in some variants of junctional epidermolysis bullosa, such as generalized atrophic benign epidermolysis bullosa.

Adult↗
PubMedDate not supplied

Internal brow elevation at blepharoplasty.

OBJECTIVE: To present data on a transblepharoplasty technique that provides a safe and reliable brow elevation and glabellar furrow reduction by releasing inferior tethering and weakening the brow depressor muscles. DESIGN: Nonrandomized retrospective case series and surgical technique description. RESULTS: One thousand patients who underwent internal brow elevation for cosmesis associated with upper blepharoplasty over the past 9 years were reviewed. Follow-up ranged from 6 months to 9 years. There were no serious long-term complications. All patients experienced forehead hypesthesia, which was temporary in most patients. Only 2 patients complained of prolonged and bothersome forehead hypesthesia lasting longer than 2 years. CONCLUSION: The internal brow elevation at blepharoplasty is a reproducibly safe and effective technique to improve eyebrow appearance without fixation.

Blepharoplasty↗
PubMed1999

Ocular findings in ichthyosis follicularis, atrichia, and photophobia syndrome.

Ichthyosis follicularis, atrichia, and photophobia (IFAP) are typical features of a rare neuroichthyosis termed IFAP syndrome. We demonstrate the ultrastructural findings of the eyes from a 33-year-old patient with IFAP syndrome. Clinically, eyebrows and eyelashes were absent from birth, and photophobia was noted at the age of 1 year. The globes measured 28 and 29 mm, respectively, and both eyes showed a posterior staphyloma. Histopathologically, bilateral centrally located subepithelial avascular corneal scarring with secondary corneal amyloid deposition was found. In addition to already described ocular abnormalities in IFAP syndrome we demonstrate ultrastructural anomalies of desmosomes and tonofilaments in corneal epithelium; defects of basement membrane, Bowman layer, and anchoring fibrils; secondary corneal amyloid deposition; and keratocyte degeneration. A defective tear film, recurrent atopic keratoconjunctival inflammations, or a primary anomaly of corneal epithelial adhesion are potential causes for the corneal defects. Photophobia is most likely due to corneal abnormalities.

Abnormalities, Multiple↗
PubMed1983

Intravascular papillary endothelial hyperplasia of the orbit and ocular adnexa. A report of five cases.

This is a clinicopathologic study of five patients with intravascular papillary endothelial hyperplasia involving the orbit and ocular adnexa. The median age of the patients was 45 years. Three lesions were located in the orbit, one in the eyelid, and one in the eyebrow. Four lesions were located within a distended vein and one involved an artery. The walls of the vessel corresponded to the "capsule" of the circumscribed mass. The lumen disclosed different stages of organization of a thrombus with prominent endothelial cell proliferation centered around cores of collagenous tissue and fibrin. Electron microscopy of one lesion displayed spindle-shaped cells with features of endothelial cells forming a polarized basement membrane with numerous micropinocytotic vesicles on their plasmalemma. Some cells showed ultrastructural features of pericytes. The lesion, which may be confused with angiosarcoma, represents an unusual exuberant proliferation of vascular endothelium as a cellular response to the organization of a thrombus.

Adult↗
PubMed1984

Treatment of essential blepharospasm. II. A modification of exposure for the muscle stripping technique.

The refinement of a muscle excision technique for the correction of essential blepharospasm has been a major contribution to treatment. In this procedure, incisions are made directly above the eyebrow to excise the brow muscles, often resulting in adherent scars and poor brow position. The bicoronal scalp flap has been used by many other surgical subspecialities for exposure of the frontal bone area, eg, in neurosurgical procedures, sinus surgery, and cosmetic forehead lifts. The use of the coronal flap exposure for excision of the corrugator and procerus muscles has allowed them to be more easily excised and has avoided the problems associated with the direct brow incisions. The Anderson muscle stripping technique, combined with the coronal flap exposure for the brow muscles, provides the best correction for the spasms in patients who have essential blepharospasm. The frequency of complications is low, and patient acceptance is high.

Blepharospasm↗
PubMed1998

Comparison of subperiosteal vs subgaleal elevation techniques used in forehead lifts.

OBJECTIVES: To compare eyebrow and forehead elevation and tension among the following 3 surgical techniques: subperiosteal dissection to the supraorbital rim, subperiosteal dissection with release (elevation, incision, and spread) of periosteum at the supraorbital rim, and subgaleal dissection to the supraorbital rim, and to determine the optimal method of elevation in an aesthetically accepted range for the endoscopic forehead lift. DESIGN: A randomized, self-controlled study using an open approach to the forehead in cadaver heads. Each half of head was compared with the other in the following 2 study groups: subperiosteal dissection without release vs subperiosteal dissection with release of periosteum (group 1) and subperiosteal dissection with release of periosteum vs subgaleal dissection. SETTING: Anatomy laboratory at a university medical center. SUBJECTS: Eight cadaver heads fixed with ethylene glycol in each group. INTERVENTION: Predissection distances in millimeters from fixed anatomic landmarks were measured. The forehead flaps were elevated using a coronal incision and divided with a midline incision for side-to-side comparison. Cadaver heads and side of surgical intervention were selected randomly. The flap tensions associated with incremental flap advancement of 0.5 and 1.0 cm were measured. Traction of 2.2 kg was then applied to each flap, and distances between the fixed landmarks were measured. MAIN OUTCOME MEASURES: Mean predissection and postdissection distance of brow and forehead elevation for each dissection type and mean distance and median tension of brow and forehead elevation within each group. RESULTS: The mean postdissection brow measurements at rest were significantly greater than the mean predissection measurements at most landmarks in all dissections for both groups (P<.05). The mean postdissection brow and forehead measurements with 2.2 kg of traction were significantly greater than the mean predissection measurements at all landmarks in all dissections for both groups (P<.05). The mean increase in distance from predissection to postdissection (at rest and with 2.2 kg of traction) did not significantly differ between the different dissection types (P>.05). For group 1, the median flap tension for subperiosteal dissection without release was greater than that for subperiosteal dissection with release (P>.05). For group 2, subperiosteal dissection with release had greater median flap tension than subgaleal dissection (P>.05). CONCLUSIONS: All 3 methods of dissection significantly elevated the brow at rest for most landmarks. All 3 methods of dissection significantly elevated the brow and forehead when traction was applied to the flap. Brow and forehead elevation at rest and with 2.2 kg of traction did not significantly differ between the dissections. Subgaleal dissection was associated with less flap tension compared with the subperiosteal dissection with or without release. The data support the use of all 3 methods of forehead dissection for brow elevation and subgaleal forehead dissection as the optimal approach for the forehead lift, whether performed endoscopically or open.

Aged↗
PubMed1986

Coronal approach for rejuvenation of the eyes and forehead.

Aesthetic surgeons are using the coronal forehead lift to achieve more consistent and enduring results due to a better understanding of the anatomy, dynamics, and aging process of the forehead. The varied indications for the procedure, such as soft-tissue ptosis and facial wrinkles, are discussed. The surgical technique is described, including the many controversial methods of managing the frontalis muscle. Eyeglasses and precise photography are employed to more objectively evaluate the amount of eyebrow elevation. Very gratifying results have been achieved with only minimal complications. The coronal forehead lift enhances the effects of the standard blepharoplasty and the orbicularis oculi muscle flap suspension techniques, and can be done in conjunction with a facial-cervical rhytidectomy. Presently, this is the procedure of choice in most women for rejuvenating the upper third of the face.

Adult↗
PubMed1989

The effect of facial animation on the aging upper half of the face.

Sixty patients, ranging in age from 29 to 74 years, were studied for the effect of animation of the upper half of the face on the aging features. Patients were divided into three categories according to the dominant behavioral pattern: brow lifters, frowners, and squinters. Brow ptosis was accentuated laterally in the squinters and medially in the frowners. The brow-lifter group showed more uniform displacement of the eyebrow. The coarse wrinkles or the animation lines also correlated well with the animation pattern. These patterns are acquired in childhood and remain subconsciously in effect throughout adult life and therefore have a significant effect on brow ptosis.

Adult↗
PubMed1998

Acquired hypertrichosis lanuginosa: case report and review of the literature.

Acquired hypertrichosis lanuginosa is a rare cutaneous disorder usually associated with internal malignancy that consists of the development of abnormal hair growth of the lanugo type, often confined to the skin of the face and neck, although other areas also may be involved. We report on a 66-year-old woman with a metastatic ductal infiltrating carcinoma of the breast who developed growth of fine lanugo type hair on her face and progressive growth of the hair of eyebrows and eyelashes. We review the literature on this uncommon paraneoplastic cutaneous disorder emphasizing the pathogenic mechanisms that have been proposed to explain the striking overgrowth of lanugo type hair.

Aged↗
PubMed1982

The nasopalpebral lipoma-coloboma syndrome: a new autosomal dominant dysplasia-malformation syndrome with congenital nasopalpebral lipomas, eyelid colobomas, telecanthus, and maxillary hypoplasia.

We describe a new autosomal dominant dysplasia-malformation syndrome from eight affected individuals in three generations of a Venezuelan family. It is characterized by congenital symmetrical upper lid and nasopalpebral lipomas, bilateral symmetrical upper and lower palpebral colobomas located at the junction of the inner and middle thirds of the lids, telecanthus, and maxillary hypoplasia. Affected individuals have a broad forehead, window's peak, abnormal pattern of eyebrows and eyelashes, and maldevelopment of the lacrimal punctae. Interorbital distance is normal, but interpupillary distance is increased due to divergent strabismus originating from visual interference from inner canthal masses. Persistent epiphora, conjunctival hyperemia, and corneal (and less frequently lens) opacities are a secondary consequence of the defect of the lacrimal punctae and the inability to close the lids completely. The syndrome has complete penetrance and a rather narrow range of expressivity. The primary defect could involve a dysplasia of adipose tissue leading to nasopalpebral and upper lid lipomas during embryogenesis, with the rest of the malformations being secondary to interference of morphogenesis of the mid-upperface developmental field from the lipomatous hamartomas. Alternatively, a central rather than a peripheral mechanism of malformation might be considered, such as defective migration of neural crest cells.

Abnormalities, Multiple↗
PubMedDate not supplied

The application of hair-bearing flaps in head and neck surgery.

The history of hair-bearing flaps is presented. A study of the vascular supply of the scalp with a particular emphasis on the posterior branch of the superficial temporal artery revealed that it was possible to transpose the entire scalp or any hair-bearing flap on a long, highly mobile, narrow pedicle containing this vessel. Clinical application of this finding to postexcisional defects allowed the reconstruction of hairline, eyebrows, sideburns, and various shapes of beards and moustaches. The technique was used on 80 occasions to produce various cosmetic units and proved to be a safe procedure.

Adult↗
PubMed1977

Stages in the post-hatching development of Aplysia californica.

In order to study the development of the nervous system of the marine mollusc, Aplysia californica, it is necessary objectively to assess the maturity of individual specimens. This can be done by defining stages in the life cycle. The post-hatching development can be divided into four phases: planktonic, metamorphic, juvenile, and adult. These phases can be further subdivided into 13 stages on the basis of behavioral and morphological characteristics visible in living specimens: Stage 1, newly hatched; Stage 2, eyes develop; Stage 3, the larval heart beats; Stage 4, maximum shell size is reached; Stage 5, the propodium develops; Stage 6, red spots appear; Stage 7, the velum is shed; Stage 8, eyebrows appear; Stage 9, pink color develops; Stage 10, white spots appear; Stage 11, rhinophores grow; Stage 12, the genital groove forms; Stage 13, egg laying begins. Reconstructions from serial sections taken from specimens fixed at each of these stages reveal the sequence of formation of the major organ systems. The nervous system develops gradually. The cerebral and pedal ganglia are present at Stage 1, the optic ganglia develop at Stage 2, the abdominal, pleural, and osphradial ganglia at Stage 3, the buccal ganglia at Stage 5, and the genital ganglion at Stage 13. Because Aplysia develops gradually, it is possible to analyze the contribution which gastropod torsion makes to the different phases of the life cycle. The Aplysia embryo undergoes 120 degrees torsion prior to Stage 1. The major visceral organs, the digestive system, heart, gill, and visceral nervous system, develop sybsequently in their post-torsional positions. After metamorphosis, there is a partial de-torsion which involves only the digestive system. Torsion of the digestive system may therefore be beneficial only to the pre-metamorphic larva, and not to the postmetamorphic juvenile.

Animals↗