Procedures :: Surgical
The incision can be made by means of a w-plasty to hide the scar, and is made immediately inside the hair implant line. It is chamfered underneath to permit the preservation of the hair follicles and hair to grow through the incision. The disadvantages of this procedure includes the need to traverse the medial line with the incision in the scalp and resulting numbness of the post hair implant line, which occurs because of need to section the supraorbital nerve in the hair implant line. The bi-plane and trycophytic endoscopic procedures maintain both the position of the hair implant line and that of the supraorbital nerve.
Patients that have high hair implant lines and deep wrinkles on the forehead are candidates who are suited for the mesofacial lift. This is also an excellent aesthetical paralyzed forehead rejuvenation option. The incision / ellipses is made alongside a forehead crease, which is completely incised. The incision may be staggered along the medial or para-medial line or it may be continuous, crossing the medial line. The temporal lift is effective in women with lateral excess skin (hooding) or lateral ptosis of the eyebrow.
The direct lift procedure is rarely used. For the majority of surgeons, this procedure is reserved for the reanimation of paralysis of the facial nerve or to be used on aged patients who are not too concerned with the resultant scarring. Its advantage is that the eyebrow can be positioned exactly as desired. This is advantages to the patient who has excessive skin but who cannot protect his eyes because of the paralysis.
Consequently, the precise placement of the eyebrow may be required.3 The different incisions for the procedures mentioned are shown in Figure 17.6
Figure 17.6 Variations in the incisions on hair implant line for the eyebrow lift. A Pretrechial / trycophytic incisions, green. B Coronal incision, yello. C incisions by means of endoscopy, red.
LIFTING OF THE EYEBROW BY WAY OF A CORONAL INCISION
The coronal incision for lifting the eyebrows was first described in 1926 by Hunt8. The incisions are made inside the scalp and in the previous hair implant line. The modern procedure involves making a curvilinear incision 4 to 6 cm posterior to the hair implant line. This procedure has withstood the test of time and continues to be the most reliable method for treating a low hair implant line, sever ptosis of the eyebrows and excessive wrinkles on the forehead.
The longevity of this procedure has been well document in reference works9. Some even consider such a feat to be an overwhelming victory, achieved at the cost of the collateral effects, such as scaring, alopecia, hypoesthesia of the scalp and posterior displacement of the anterior scalp. Also, this procedure should be avoided in younger men younger men because of the risk of male-pattern baldness developing later.
During the procedure, the incision of is performed posterior to the hair implant line. The incisions should be chamfered so as to preserve the hair follicles. The cut is generally elevated along the subgaleal plane and the incision extends 1-2cm into the helical root. The dissection is performed along the midline in a cutting manner within 1cm of the glabella. At this point, the corrugator and procerus muscles are dissected once the neurovascular bundles has been identified and preserved. They may be cauterized by means of bipolar cauterization, and thereafter cut or avulsed. Laterally, the dissection is made along the temporal line until the superficial layer of the deep temporal fascia. Once the supraorbital rim has been identified, care should be taken not cause damage to the neurovascular bundle of the supraorbital and supratrochlear nerves. The conjoint tendon, the marginal arch and the periosteum along the supraorbital rim are then connected. At the point, the eyebrows should capable of movement and the frontalis muscle can be incised to enhance the removal of the wrinkles of the forehead. The outline is then recovered from the back and above and the redundant skin is excised. A slight adjustment is then carried out enable the tissue to straighten. The wound is closed in two layers with special precision so as to reconnect the galea and the incision in the scalp is closed with staples.< Previous Next >