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PubMedDate not supplied

The subgaleal endoscopic browlift.

Most endoscopic browlifts are performed in a subperiosteal plane with or without fixation posterior to the hairline at the incision site. The extent and longevity of browlifting are variable and somewhat unpredictable. We reviewed the literature on endoscopic browlifting techniques and describe herein our technique for the subgaleal endoscopic browlift procedure. It differs from the published reports of subperiosteal endoscopic techniques in the plane of dissection, circumvention of a periosteal release, and suture fixation at the brow level. We have used this technique for browlifting in male and female patients alike, as well as in patients with preoperative brow asymmetries, with consistent results.

Endoscopy↗
PubMedDate not supplied

Anatomy of the corrugator supercilii muscle.

OBJECTIVE: To define the anatomy of the corrugator supercilii muscle (CSM). DESIGN: Cadaver dissections following a preset approach. SETTING: Anatomy laboratory at a medical school. METHOD: Sixteen sides of 8 preserved cadaver heads were dissected. Inferiorly based trapdoor-type flaps were developed in the subgaleal plane. The bone origins of the CSM were first identified. The muscles were then followed to their insertions. The origin and outline of the muscles were plotted on the face of the cadaver. Following the measurements, we transferred the configuration of the CSM to the image of a computer-manipulated face of a model. RESULTS: The origin of the CSM has a wide base, spanning across 0.6 cm from the midline and the supraorbital notch/foramen. The area of the muscle origin measured 0.98 x 2.52 cm on the right side and 1.04 x 2.35 cm on the left side. The lateral extent of the CSM insertion measured 4.27 and 4.50 cm from the midline on the right and left sides, respectively. CONCLUSIONS: The CSM originates as 3 or 4 thin, rectangular, panellike muscle groups occupying a wide area across 0.6 cm from the midline and the supraorbital notch/foramen. The muscle groups travel parallel to one another in an oblique course without distinguishable oblique or transverse components.

Cadaver↗
PubMedDate not supplied

Use of the endoscopic forehead-lift to improve brow position in persistent facial paralysis.

Traditionally, the asymmetrical brow in facial paralysis has been treated with open procedures. There are few data that support the use of endoscopic procedures to treat patients with facial palsy or paralysis. We sought to evaluate a single surgeon's experience with the use of endoscopic forehead-lifts to treat asymmetrical brow positioning resulting from facial nerve disorders. All cases involving patients who underwent endoscopic brow-lifts by the senior author (Y.D.) from 1997 through 2003 with a minimum follow-up of 12 months were retrospectively reviewed. Demographic data were collected, and patient satisfaction was determined from postoperative interviews conducted at follow-up visits. Standard photographs were used to measure the degree of preoperative and postoperative brow asymmetry. A total of 31 cases were available for review. The average age of our patient population was 47 years (age range, 22-76 years), with a male-female ratio of almost 1.5:1. Twenty-three patients had a complete paralysis, and 8 patients had a palsy. The average preoperative difference in height at the desired apex of brow was 5.9 mm, with a range of 3.0 to 9.0 mm. The average postoperative difference (as measured at 12 months) in brow position was only 1.3 mm, with a range of 0 to 3 mm. Adjunctive periorbital procedures were performed in the majority of patients (90%) at the time of endoscopic brow-lifting. All patients felt that their brow position was much improved after surgery. No major complications were encountered. A single patient underwent a secondary open direct browpexy to optimize his result. Endoscopic brow-lifting may be associated with favorable outcomes in the majority of patients with facial nerve palsy or paralysis. Performing concurrent adjunctive periorbital procedures as deemed necessary to optimize lower eyelid position, eyelid closure, and upper eyelid symmetry appears to be safe and reliable.

Endoscopy↗
PubMedDate not supplied

Use of BioGlue surgical adhesive for brow fixation in endoscopic browplasty.

OBJECTIVE: To determine the efficacy, longevity, and safety of BioGlue Surgical Adhesive for periosteal fixation in endoscopic browlifts. METHODS: Retrospective review of 80 patients who underwent endoscopic browlift using BioGlue as the primary means of periosteal fixation. Visits were categorized as preoperative, 1 to 2 months, 3 to 6 months, and 7 to 12 months, and photographs of the first 15 patients were evaluated for change in brow position at each of these visits. Brow position was measured at the lowest brow hairs at the midpupillary and lateral canthus positions. Follow-up was 3 months to 3 years. RESULTS: All of the first 15 patients were included in the 1- to 2-month postoperative grouping, 13 in the 3- to 6-month grouping, and 10 in the 7- to 12-month grouping. At all postoperative visits, brow elevation was significantly maintained during 12-month follow-up. Revision has been required in only 1 of 80 patients to date. CONCLUSIONS: BioGlue is an effective and safe method of maintaining brow position in endoscopic browplasty. Brow elevation achieved using BioGlue was significantly maintained during the 7- to 12-month postoperative period. Tissue adhesives such as BioGlue have the potential to become significant adjuncts in facial plastic surgery and warrant more critical evaluation.

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