Subscribe to RSS
DOI: 10.1055/s-2007-970130
Evolution in Techniques for Endsocopic Brow Lift with Deep Temporal Fixation Only and Lower Blepharoplasty-Transconjunctival Fat Repositioning
Publication History
Publication Date:
02 March 2007 (online)
![](https://www.thieme-connect.de/media/fps/200701/lookinside/thumbnails/10.1055-s-2007-970130-1.jpg)
ABSTRACT
As we become more confident with our surgical skills following our fellowship training, some of our approaches and techniques will be modified or changed. My primary evolutionary change involves procedures of the upper third of the face, primarily the brow lift and treatment of lower eyelid fat techniques. Traditional methods of forehead and brow rejuvenation, such as coronal, pretrichal, and direct brow lifts, have provided facial plastic surgeons with effective brow elevation for many years. In the past decade, the endoscopic brow lift has rapidly become accepted as part of the surgical armamentarium and is frequently the technique of choice. In general, the temporal dissection, temporal fixation, forehead subperiosteal or subgaleal dissection with release, and treatment to the brow depressor musculature have been standardized. Methods of bony fixation remain a controversial topic as there are numerous methods. We advocate deep temporal fixation only without bone fixation to achieve effective, long-term brow elevation. Traditionally, lower eyelid herniated fat is removed, which may cause a sunken or hollow lid appearance, especially in patients with a tear trough deformity (nasojugal groove). Lower eyelid transconjunctival fat repositioning, defined as the subperiosteal repositioning of the medial and central lower eyelid herniated orbital fat into the nasojugal fold, may prevent the surgical, hollow lower eyelid appearance while treating the herniated fat. Fat repositioning may be combined with an endoscopic subperiosteal midface-lift, transcutaneous skin pinch, and transconjunctival orbicularis oculi excision. This technique offers a powerful tool in the surgical armamentarium of the facial plastic surgeon.
KEYWORDS
Endoscopic brow lift - endoscopic forehead lift - forehead lift - brow lift - brow ptosis - lower blepharoplasty - fat repositioning - transconjunctival blepharoplasty - dermatochalasis
REFERENCES
- 1 Nassif P S, Kokoska M S, Cooper P et al.. Comparison of subperiosteal vs. subgaleal elevation techniques used in forehead lifts. Arch Otolaryngol Head Neck Surg. 1998; 124 1209-1215
- 2 Nassif P S, Massry G G. Endoscopic brow lift: is bone fixation necessary?. Presented at the Seventeenth Annual Symposium on the Latest Advances in Cosmetic Surgery of the Face, Newport Beach, California, August 8, 2003
-
3 Nassif P S, Thomas J R.
Management of the aging brow and forehead . In: Cummings CW, Flint PW Otolaryngology Head & Neck Surgery. 4th ed. Philadelphia, PA; Elsevier Mosby 2005: 750-763 - 4 Nassif P S. Endoscopic brow lift with deep temple fixation only (DTFO). Facial Plastic Surg Clin North Am. 2006; 14 203-211
- 5 Pitanguy I. Indications and treatment of frontal and glabellar wrinkles in an analysis of 3,404 consecutive cases of rhytidectomy. Plast Reconstr Surg. 1981; 67 157-166
- 6 Castanares S. Forehead wrinkles, glabellar frown and ptosis of the eyebrows. Plast Reconstr Surg. 1964; 34 406
- 7 Isse N G. Endoscopic facial rejuvenation: endoforehead, the functional lift: case Reports. Aesthetic Plast Surg. 1994; 18 21-29
- 8 Ramirez O M. Endoscopic subperiosteal browlift and facelift. Clin Plast Surg. 1995; 22 639-660
- 9 Vasconez L O, Core G B, Gamboa-Bobadilla M et al.. Endoscopic techniques in coronal brow lifting. Plast Reconstr Surg. 1994; 94 788-793
- 10 Cousin J N, Ellis D A. Fibrin glue as the sole fixator in endoscopic forehead lift. Presented at the Canadian Society of Otolaryngology-Head & Neck Surgery annual meeting, Toronto, Ontario, May 30, 2000
- 11 Marchac D, Ascherman J, Arnaud E. Fibrin glue fixation in forehead endoscopy: evaluation of our experience with 206 cases. Plast Reconstr Surg. 1997; 100 704
- 12 De La Fuente A, Santamaria A B. Facial rejuvenation: a combined conventional and endoscopic assisted lift. Aesthetic Plast Surg. 1996; 20 471-479
- 13 Oslin B, Core G B, Vasconez L O. The biplanar endoscopically assisted forehead lift. Clin Plast Surg. 1995; 22 633-638
- 14 Sclafani A P, Fozo M S, Romo T et al.. Strength and histological characteristics of periosteal fixation to bone after elevation. Arch Facial Plast Surg. 2003; 5 63
- 15 Zimbler M S, Nassif P S. Adjunctive applications for botulinum toxin in facial aesthetic surgery. Facial Plast Surg Clin North Am. 2003; 11 477-482
- 16 Larrabee W F, Makielski K H, Cupp C. Facelift anatomy. Facial Plast Surg Clin North Am. 1993; 1 135-152
- 17 Pitanguy I, Ramos A S. The frontal branch of the facial nerve: the importance of its variations in face lifting. Plast Reconstr Surg. 1966; 38 352-356
- 18 Tardy ME, Thomas JR, Brown R Facial Aesthetic Surgery. 1st ed. St. Louis, MO; Mosby 1995
- 19 Baylis H I, Long J A, Groth M J. Transconjunctival lower eyelid blepharoplasty: technique and complications. Ophthalmology. 1989; 96 1027-1032
- 20 Goldberg R A, Lesner A M, Shorr N, Baylis H I. The transconjunctival approach to the orbital floor and orbital fat: a prospective study. Ophthalmic Plast Reconstr Surg. 1990; 6 241-246
-
21 Baylis H I, Goldberg R A, Groth M J.
Complications of lower blepharoplasty . In: Putterman AM Cosmetic Oculoplastic Surgery: Eyelid, Forehead, and Facial Techniques. 3rd ed. Philadelphia, PA; WB Saunders 1999: 429-456 - 22 Kikkawa D O, Lemke B N, Dortzbach R K. Relations of the superficial musculoaponeurotic system to the orbit and characterization of the orbitomalar ligament. Ophthalmic Plast Reconstr Surg. 1996; 12 77-88
- 23 Hamra S T. The role of orbital fat preservation in facial aesthetic surgery: a new concept. Clin Plast Surg. 1996; 23 17-28
- 24 Nassif P S. Lower blepharoplasty: transconjunctival fat repositioning. Facial Plastic Surg Clin North Am. 2005; 13 553-559
Paul S NassifM.D. F.A.C.S.
Spalding Drive Cosmetic Surgery & Dermatology
120 S. Spalding Drive, Suite 315, Beverly Hills, CA 90212