Thursday, January 31, 2008 - 11:34 AM
13785

Subcutaneous Temporal Brow Lift Under Local Anesthesia, A Useful Technique for Periorbital Rejuvenation

Rafi S. Bidros, MD, Hector Salazar-Reyes, MD, and Jeffrey D. Friedman, MD.

BACKGROUND: Various techniques have been described for periorbital rejuvenation and correction of the ptotic brow. The endoscopic brow lift is a popular method but does not apply to every patient. In addition to elevating the hair line, there are added facility costs and the typical use of general anesthesia. This method can sometimes be unjustifiable, especially if one is performing this sole procedure. Previously described, is the brow lift with limited incisions in the subcutaneous plane. This allows less scalp numbness with pretrichial incisions. The authors describe the usefulness of the subcutaneous temporal brow lift performed under local anesthesia in the office setting. METHODS: A description of the procedure and a retrospective chart review of patients treated with this approach since 2003 are presented. The area of dissection is infiltrated with epinephrine-containing lidocaine solution. The surgical approach consists of lateral frontal pretrichial incisions that can be extended in the temporal hair bearing scalp. A subcutaneous plane is elevated to the level of the brow. The brow is lifted in a vector that is ideal for the patient, and the excess skin is excised. We compared preoperative and postoperative photographs for effectiveness (Figure 1). RESULTS: A total of 20 patients underwent this procedure between July, 2003 and January, 2007 by the senior author (JDF). Four patients underwent a unilateral brow lift for asymmetrical ptosis. The mean age of patients was 54 years and mean length of follow up was 10.8 months. Only one patient required scar revision; otherwise, all achieved good to excellent results and satisfaction. Facility costs associated with the procedure averaged $400. CONCLUSIONS: For select patients, especially those with lateral brow ptosis and a high frontal hair line, the subcutaneous temporal brow lift performed under local anesthesia has proven effective, reproducible and inexpensive. It also allows a greater degree of controlling the vector and extent of the lift. Several authors have described their series of well proven methods for brow lifting. This adds to the armamentarium of techniques for facial rejuvenation in the era of minimally invasive surgery.