Facial Plast Surg 2023; 39(06): 691-702
DOI: 10.1055/a-1953-2304
Original Research

The Temporal Subcutaneous Brow Lift with Orbicularis Oculi Muscle Elastic Flap: Technical Considerations, Systematic Review, and Terminology Standardization

Michele Pascali
1   Plastic Surgery Academy, Rome, Italy
,
Olindo Massarelli 
2   Department of Mental Health and Sense Organs, Maxillofacial Surgery Operative Unit, Santa Maria Le Scotte, University Hospital of Siena, Italy
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objectives As the face ages, cosmetic changes in the periorbital region including eyebrow ptosis, sagging in the lateral temporo-orbital region with superior eyelid hooding, ptosis of orbicularis oculi muscle associated with drooping of the malar area with multiple “crow feets”, a deeper lid-cheek junction, and malar festoons also occur. All these periorbital structures should be considered as a single anatomical entity.

Methods Numerous techniques have been described to correct brow aesthetics in facial rejuvenation. We report the senior author's (M.P.) current approach utilizing a temporal subcutaneous brow lift (TSBL) associated with an orbicularis oculi muscle (OOM) elastic flap. Furthermore, a systematic review of the literature was performed comparing the different surgical approaches striving to clarify its terminology. A total of 298 patients underwent this procedure in 4 years period. Of these, 230 patients, with at least 12 months of follow-up, were submitted to subjective and objective methods to evaluate the self-perception of scar and their overall aesthetic satisfaction. A committee of experts, blinded to each other's assessment, evaluated the same outcomes. Total eyebrow's tail lift was measured and recorded for each patients.

Results The most satisfying aspect of these techniques is the dramatic periorbital rejuvenation and preservation of the patient's original youthful identity. In fact, the postoperative results appear very natural and do not suffer from an “operated” look. This aspect is noticeable from both the surgeon's and the patient's perceptions. There were no major complications in any of the cases.

Conclusions The proposed TSBL with OOM elastic flap technique, in the hands of senior author (M.P.) has emerged as a reliable, effective, and highly reproducible method to treat sagging and aging of the lateral region of the orbit, even without associated blepharoplasties.

Keywords

eyebrow lift - temporal lift - orbicularis muscle - periorbital rejuvenation


Publication History

Accepted Manuscript online:
29 September 2022

Article published online:
15 December 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Furnas DW. Festoons of orbicularis muscle as a cause of baggy eyelids. Plast Reconstr Surg 1978; 61 (04) 540-546
    CrossrefPubMedGoogle Scholar
  • 2 Moss CJ, Mendelson BC, Taylor GI. Surgical anatomy of the ligamentous attachments in the temple and periorbital regions. Plast Reconstr Surg 2000; 105 (04) 1475-1490
    PubMedGoogle Scholar
  • 3 Zufferey J. Cheekbone: dynamic and anti-aging structure of the midface?. Eur J Plast Surg 2005; 27: 359-366
    CrossrefPubMedGoogle Scholar
  • 4 Park JT, Youn KH, Hur MS, Hu KS, Kim HJ, Kim HJ. Malaris muscle, the lateral muscular band of orbicularis oculi muscle. J Craniofac Surg 2011; 22 (02) 659-662
    CrossrefPubMedGoogle Scholar
  • 5 Barton Jr FE. The SMAS and the nasolabial fold. Plast Reconstr Surg 1992; 89 (06) 1054-1057
    CrossrefPubMedGoogle Scholar
  • 6 McCord Jr CD, Codner MA, Hester TR. Redraping the inferior orbicularis arc. Plast Reconstr Surg 1998; 102 (07) 2471-2479
    CrossrefPubMedGoogle Scholar
  • 7 Matarasso A, Terino EO. Forehead-brow rhytidoplasty: reassessing the goals. Plast Reconstr Surg 1994; 93 (07) 1378-1389 , discussion 1390–1391
    CrossrefPubMedGoogle Scholar
  • 8 McCord CD, Doxanas MT. Browplasty and browpexy: an adjunct to blepharoplasty. Plast Reconstr Surg 1990; 86 (02) 248-254
    CrossrefPubMedGoogle Scholar
  • 9 Burroughs JR, Bearden WH, Anderson RL, McCann JD. Internal brow elevation at blepharoplasty. Arch Facial Plast Surg 2006; 8 (01) 36-41
    CrossrefPubMedGoogle Scholar
  • 10 Vinas JC, Caviglia C, Cortinas JL. Forehead rhytidoplasty and brow lifting. Plast Reconstr Surg 1976; 57 (04) 445-454
    CrossrefPubMedGoogle Scholar
  • 11 Pascali M, Bocchini I, Avantaggiato A. et al. Direct brow lifting: Specific indications for a simplified approach to eyebrow ptosis. Indian J Plast Surg 2016; 49 (01) 66-71
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Fedok FG. The trichophytic and lateral temporal lifts: application to the focal elevation of the aging lateral eyebrow. Facial Plast Surg 2018; 34 (02) 150-154
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Miller TA. Lateral subcutaneous brow lift. Aesthet Surg J 2003; 23 (03) 205-210
    CrossrefPubMedGoogle Scholar
  • 14 Bidros RS, Salazar-Reyes H, Friedman JD. Subcutaneous temporal browlift under local anesthesia: a useful technique for periorbital rejuvenation. Aesthet Surg J 2010; 30 (06) 783-788
    CrossrefPubMedGoogle Scholar
  • 15 Savetsky IL, Matarasso A. Lateral temporal subcutaneous brow lift: clinical experience and systematic review of the literature. Plast Reconstr Surg Glob Open 2020; 8 (04) e2764
    CrossrefPubMedGoogle Scholar
  • 16 Cló TCT, Flavio WF, Cló FX, Ribeiro GVC. Temporal lift with repositioning of the orbicular muscle and eyebrow tail. Rev Bras Cir Plást 2022; 37 (01) 9-15
    PubMedGoogle Scholar
  • 17 Aston SJ. Orbicularis oculi muscle flaps: a technique to reduce crows feet and lateral canthal skin folds. Plast Reconstr Surg 1980; 65 (02) 206-216
    CrossrefPubMedGoogle Scholar
  • 18 Fogli AL. Orbicularis muscleplasty and face lift: a better orbital contour. Plast Reconstr Surg 1995; 96 (07) 1560-1570
    CrossrefPubMedGoogle Scholar
  • 19 Guerrissi JO. Periorbital rejuvenation: a safe subcutaneous approach to forehead, eyebrow, and orbicularis oculis muscle mobilization. Aesthetic Plast Surg 2010; 34 (02) 147-152
    CrossrefPubMedGoogle Scholar
  • 20 Pascali M, Gualdi A, Bottini DJ, Botti C, Botti G, Cervelli V. An original application of the Endotine Ribbon device for brow lift. Plast Reconstr Surg 2009; 124 (05) 1652-1661
    CrossrefPubMedGoogle Scholar
  • 21 Pascali M, Bocchini I, Avantaggiato A, Cervelli V. 2014 SICPRE proceedings: meeting proceedings. Plast Reconstr Surg Glob Open 2015; 3 (03) e337
    PubMedGoogle Scholar
  • 22 Massarelli O, Gobbi R, Soma D, Raho MT, Tullio A. An aesthetically possible alternative approach for craniomaxillofacial trauma: the “pretrichial incision”. Craniomaxillofac Trauma Reconstr 2011; 4 (03) 161-170
    CrossrefPubMedGoogle Scholar
  • 23 Massarelli O, Vaira LA, De Riu G. A new aesthetic pretrichial approach for upper third-facial fractures and pathologies: the “Crown incision”. J Plast Reconstr Aesthet Surg 2022; 75 (02) 788-796
    CrossrefPubMedGoogle Scholar
  • 24 Hwang K, Nam YS, Kim DJ, Han SH, Hwang SH. Anatomic study of the lateral palpebral raphe and lateral palpebral ligament. Ann Plast Surg 2009; 62 (03) 232-236
    CrossrefPubMedGoogle Scholar
  • 25 Pitanguy I, Ramos AS. The frontal branch of the facial nerve: the importance of its variations in face lifting. Plast Reconstr Surg 1966; 38 (04) 352-356
    CrossrefPubMedGoogle Scholar
  • 26 Pankratz J, Baer J, Mayer C. et al. Depth transitions of the frontal branch of the facial nerve: implications in SMAS rhytidectomy. JPRAS Open 2020; 26: 101-108
    CrossrefPubMedGoogle Scholar
  • 27 Barton Jr FE. The “high SMAS” face lift technique. Aesthet Surg J 2002; 22 (05) 481-486
    CrossrefPubMedGoogle Scholar
  • 28 Lee HB, Lee SH, Kim JS, Rhee SC. Evaluation of influence of individual facial aesthetic subunits on the cognition offacial attractiveness in public. Arch Plast Surg 2010; 37 (04) 361-368
    PubMedGoogle Scholar
  • 29 Warren RJ. The modified lateral brow lift. Aesthet Surg J 2009; 29 (02) 158-166
    CrossrefPubMedGoogle Scholar
  • 30 Knize DM. Forehead lift. In: Grabb & Smith's Plastic Surgery, 6th ed. Lippincott Williams & Wilkins; Philadelphia: 2007
    Google Scholar
  • 31 Gonzalez-Ulloa M. Facial wrinkles. Integral elimination. Plast Reconstr Surg Transplant Bull 1962; 29: 658-673
    CrossrefPubMedGoogle Scholar
  • 32 Ortiz-Monasterio F, Barrera G, Olmedo A. The coronal incision in rhytidectomy—the brow lift. Clin Plast Surg 1978; 5 (01) 167-179
    CrossrefPubMedGoogle Scholar
  • 33 Mahmood U, Baker Jr JL. Lateral subcutaneous brow lift: updated technique. Aesthet Surg J 2015; 35 (05) 621-624
    CrossrefPubMedGoogle Scholar
  • 34 Swift RW, Nolan WB, Aston SJ, Basner AL. Endoscopic brow lift: objective results after 1 year. Aesthet Surg J 1999; 19: 287-292
    CrossrefPubMedGoogle Scholar
  • 35 Sulamanidze MA, Fournier PF, Paikidze TG, Sulamanidze GM. Removal of facial soft tissue ptosis with special threads. Dermatol Surg 2002; 28 (05) 367-371
    PubMedGoogle Scholar
  • 36 Viterbo F, Auersvald A, O'Daniel TG. Gliding brow lift (GBL): a new concept. Aesthetic Plast Surg 2019; 43 (06) 1536-1546
    CrossrefPubMedGoogle Scholar
  • 37 Connell BF, Lambros VS, Neurohr GH. The forehead lift: techniques to avoid complications and produce optimal results. Aesthetic Plast Surg 1989; 13 (04) 217-237
    CrossrefPubMedGoogle Scholar
  • 38 Bernard RW, Greenwald JA, Beran SJ, Morello DC. Enhancing upper lid aesthetics with the lateral subcutaneous brow lift. Aesthet Surg J 2006; 26 (01) 19-23
    CrossrefPubMedGoogle Scholar
  • 39 Viterbo F, Lutz BS. Extended “C” myectomy of the lateral orbicularis oculi muscle-A safe and successful method for treatment of “crow's feet”. Aesthet Surg J 2006; 26 (02) 131-135
    CrossrefPubMedGoogle Scholar
  • 40 de Assis Montenegro Cido Carvalho F, Vieira da Silva Jr V, Moreira AA, Viana FO. Definitive treatment for crow's feet wrinkles by total myectomy of the lateral orbicularis oculi. Aesthetic Plast Surg 2008; 32 (05) 779-782
    CrossrefPubMedGoogle Scholar
  • 41 Skoog T. Plastic Surgery. Philadelphia: Saunders; 1975
    Google Scholar
  • 42 Bosch G, Jacobo O, Seoane J, Martirena A, de los Ríos G. The extended brow lift: the toucan technique. Aesthetic Plast Surg 2002; 26 (04) 255-262
    CrossrefPubMedGoogle Scholar
  • 43 Cabbabe SW, Andrades P, Vasconez LO. Lateral orbicularis oculi muscle plasty in conjunction with face lifting for periorbital rejuvenation. Plast Reconstr Surg 2009; 124 (04) 1285-1293
    CrossrefPubMedGoogle Scholar
  • 44 Bozola AR, Vieira R. Rhytidectomy sector time—incision intracapilar marginal and drift of the orbicularis blepharoplasty. Rev Bras Cir Plást 2013; 28 (04) 557-562
    PubMedGoogle Scholar
  • 45 Hester Jr TR, Ashinoff RL, McCord CD. Managing postseptal fat in periorbital rejuvenation: anatomic intraorbital replacement using passive septal tightening. Aesthet Surg J 2006; 26 (06) 717-724
    CrossrefPubMedGoogle Scholar
  • 46 Hester Jr TR. Discussion. Lateral orbicularis oculi muscle plasty in conjunction with face lifting for periorbital rejuvenation. Plast Reconstr Surg 2009; 124 (04) 1294-1295
    PubMedGoogle Scholar
  • 47 Mendelson BC. Extended sub-SMAS dissection and cheek elevation. Clin Plast Surg 1995; 22 (02) 325-339
    CrossrefPubMedGoogle Scholar
  • 48 Ryu MH, Moon VA, Yin W. The inclusion of orbicularis oculi muscle in the SMAS Flap in Asian facelift: anatomical consideration of orbicularis muscle and zygomaticus major muscle. Aesthetic Plast Surg 2018; 42 (02) 471-478
    CrossrefPubMedGoogle Scholar
  • 49 Ouattara D, Vacher C, de Vasconcellos JJ, Kassanyou S, Gnanazan G, N'Guessan B. Anatomical study of the variations in innervation of the orbicularis oculi by the facial nerve. Surg Radiol Anat 2004; 26 (01) 51-53
    CrossrefPubMedGoogle Scholar
  • 50 Innocenti A, Dreassi E, Carla V, Melita D, Innocenti M. Evaluation of residual neuro-muscular integrity in the orbicularis oculi muscle after lower eyelid transcutaneous blepharoplasty according to Reidy Adamson-s flap. Aesthetic Plast Surg 2020; 44 (05) 1577-1583
    CrossrefPubMedGoogle Scholar