Introduction

Minimally-invasive techniques can correct laxity, asymmetry and ptosis of the soft-tissues of the brow that produce the stigmata of aging.  However, few large studies have evaluated their long-term outcomes.  The senior author previously described the ligamentous attachments of the brow and how to aesthetically shape and control each eyebrow.¹ The goal of precise long-lasting control of the medial, middle, and lateral thirds of the brow and temporal region spurred further studies into the most effective and safe treatments.  

Purpose

This is an outcomes review of long-term aesthetic results and any associated complications.  

Methods

Since our publication in 2006, we have a better perspective of what is effective, safe, and how to treat and avoid complications.  This retrospective review was conducted to add an additional ten year segment between January 2000 and December 2009 to our study.  A total of 546 patients underwent endoscopic brow rejuvenation during that period.  Of these, 26 had hairline incisions for brow rejuvenation and 7 patients had scalp advancement. Medical records were reviewed for technique used and any complications.  Pre- and postoperative photos were critically analyzed.

Results

Of 546 patients reviewed, there was a high rate of concordance between patient and surgeon satisfaction with results.  Five patients had unilateral insufficient brow elevation with three undergoing revision.  At three years, brow position remained stable.   No patients had failure of their suture suspension requiring surgical intervention.  A cortical drill hole produced intra-operative CSF leak in one patient which was easily and safely treated without sequelae, which will be discussed. 

Eleven patients experienced temporary alopecia and 1 had excision of two areas of alopecia around the incision sites one year postoperatively. There were no hematomas, infections, or hypertrophic scars.

Conclusion Minimally-invasive techniques can reduce incidence of sequela including scalp scarring, paresthesias or alopecia and be very effective in terms of brow elevation verses the coronal approach, the technique still used by most plastic surgeons.  We present the senior author's preferred approach to endoscopic brow rejuvenation, long-term results, complications and treatment, and the situations in which a short scar is employed vs the hairline or coronal incisions.  We demonstrate how to avoid over-elevation brow by preserving the medial brow ligamentous attachments.  Because of the power and effectiveness of our endoscopic lift, coronal incisions have not been used in 10 years. 

1. Sullivan PK, Salomon JA, Woo AS, Freeman MB.  The importance of the retaining ligamentous attachments of the forehead for selective eyebrow reshaping and forehead rejuvenation.  Plast. Reconstr. Surg. 117, 95, 2006.
2. Barton FE.  Facial Rejuvenation.  St. Louis.  Quality Medical Publishing, 2007.