The Direct Brow Lift with Periosteal Fixation

Purpose: Although it is possible to make visible scars, direct brow lift is often performed because of the easy, quick, effective procedure and minimal morbidity when compared to other surgical approaches. However, as one grows older descent of the eyebrows is caused by stretching of forehead soft tissue, so this surgery always has a possibility of recurrence. The periosteal fixation was performed only in limited areas of some facial palsy patients due to the risk of nerve damage. Thus, we introduced the periosteum fixation by slit incision technique for the lasting elevation of eyebrow, while minimizing the risk of complications.

Methods and materials: After measuring the resection amount and design on the sitting position, an incision was made along the superior border of the eyebrow as design under the supine position with local anesthesia using 2% lidocaine and 1:100,000 dilution of epinephrine. The skin strip and subcutaneous were excised avoiding going to the orbicularis muscle with secure bleeding control. Then, the periosteum is exposed through blunt dissection in three slit opening from the muscle in the lateral two third of brow, middle, and medial regions of eyebrow taking into consideration the course of the superficial and deep branch of the supraorbital nerve and supraorbital nerve foramen. And then, we confirmed the periosteum and aponeurosis layers and checked no visible nerve on site. The dermo-subcuatenous to periosteal suture fixation were made with gently avoiding tissue severance using non-absorbable suture. During the operation we adjust symmetry and aesthetical point on the sitting position. The skin and subcutaneous suture was done and light compressive dressing was made without drain.

Result: From April 2010 to November 2017, 20 cases patient was carried out the operation. The mean follow up period was 6 months (range one to thirty six months). This group of patients consisted of 3 men and 17 women with an average age of 62 (range thirty-four to eighty years old). The elevation of brow was well maintained during follow up and most of the patients were satisfied. Only a small number of patients underwent transient postoperative paresthesia, although this symptom was spontaneously diminished over the following 2 months.

Conclusion: This surgical method was confirmed to be a reliable method for treating brow ptosis without significant complication. This technique was excellent and long lasting result compared to typical direct brow lift without sequela about supraorbital nerve injury.

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