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Board Certifications: American Board of Facial Plastic and
Reconstructive Surgery American Board of Otolaryngology - ABO

Procedures :: Surgical

The temporal incisions are chamfered and made parallel to the hair implant line. These should be maintained at a

Under a direct endoscopic view, the marginal arch is completely divided to ensure it stays deeply positioned relative to the temporoparietal fascia and superficially to the deep temporal fascia, in order to protect the facial nerve. There is a denser attachment on the in the temporal line that can be torn to join the subperiosteal and temporal planes. Since the dissection is performed on the lower aspect, it is performed under endoscopic guidance. The sentinel vein is identified approximately 1cm laterally towards the upper aspect of the orbital boarder and must be maintained. The periosteum is lifted out of the lateral orbital boarder and, afterwards, onto the malar eminence, in order to protect the facial nerve. The conjoint tendon is then, carefully released over the temporal line.

Under direct endoscopic view, the marginal arch is completely divided to ensure a successful lift. The supraorbital and supratrochlear neurovascular bundles are carefully preserved. Thereafter, the corrugators and procerus can be identified and removed (or cauterized). The suspension technique is specific to the surgeon, and many techniques were described in the literature, such as the compressive treatment only , external screws (stainless steel versus titanium), Kirschner and Endotine threads (internal absorbable attachment).3 the authors prefer attachment with Endotine in the two paramedian incisions. In the temporal region, a suspension with two threads is used, and a small ellipsis on the scalp is removed around the incision, prior to dual layered closure.

MESOFRONTAL LIFT OF THE EYEBROWS

The mesofrontal lift of the eyebrows is an option that is suited to men with deep wrinkles and who have a high or regressed hair implant line. Furthermore, it is also an excellent choice for the treatment of paralysis of the forehead in patients suffering from facial paralysis. The technique consists in the making of two separate incisions at different levels over the temporal region, which results in the removal of an ellipsis of centralized skin within a deep mesofrontal crease. The authors prefer using a continuous incision through the medial line, whilst other surgeons prefer to stagger their incisions on the different folds of the forehead.

The incisions are chamfered in order to achieve the favorable eversion of the boarder of the skin during closure. The skin and subcutaneous tissues are inferiorly excised up to the level of the frontal muscle, and a subcutaneous/suprafrontal removal plane is used inferiorly up to the level of the orbicular muscle. Afterwards, horizontal cushion suspension threads are positioned from the orbicular to the upper periosteum. Various threads are normally positioned and, once the appropriate elevation of the eyebrow has been achieved with the appropriate symmetry, the wound is closed through the use of two layers. The coetaneous layer is generally closed by using continuous Prolene suture.

In suitable patients, the mesofrontal lift of the eyebrows may provide excellent elevation in the case of marked ptosis of the eyebrow. Moreover, as a result of its proximity to the eyebrow, it encourages increased longevity and symmetry.

TEMPORAL LIFT OF THE EYEBROWS

The temporal lift of the eyebrow now comprises a large percentage of the brow lift cases of the authors. It is a desirable option for the patients, mainly women, who have excessive lateral skin (hooding) and ptosis of the lateral segment of eyebrow which presents a good placement if the medial segment. The authors are of the opinion that excellent long-terms results can be achieved through the complete release of the temporal line and the lyses of all the ligaments of the eyebrow and the marginal arch.

The elliptical temporal incision must be performed at least 1 to 2cm in the posteriorly to the temporal scalp. The incision is chamfered and parallel to the hair follicles so as to preserve them, and a suitable ellipsis of the skin is removed according to the desired degree of elevation of the eyebrow on a one to one ratio. This normally represent 1 to 2cm in maximum dimension. When the patient has an anterior hair implant line, the ellipsis should be placed 2cm posteriorly to the hair implant line.

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