Procedures :: Surgical
The dissection is performed on the superficial layer of the deep temporal fascia approximately 2cm laterally towards the lateral corner. Through adequate traction, the marginal arch and the conjoint tendon are exposed and, thereafter, freed. Once the eyebrow has been completely detached, one or two attachment sutures are applied as from the deep temporal fascia up to the temporoparietal fascia (galea). The incision is closed in two layers with staples placed on the skin.
The senior author does not make use of the procedures that follow for the purposes of elevating the eyebrow; however, for illustrative purposes, these will be briefly discussed in the following sections.
DIRECT LIFT OF THE EYEBROW
This procedure, when used, is typically performed on an aged patient who is not too concerned about the resultant scar. Moreover, it may be used to treat a unilateral paralysis of the frontal nerve.
A minor incision is made directly above the eyebrow, carefully, in order to avoid trauma to the hair follicles of the eyebrow. Thereafter, a determination is made regarding the estimated amount of skin that has to be removed, based on the desired degree of elevation and contour of the eyebrow. Afterwards, a tapered ellipsis of subcutaneous skin and tissue is cut off downwards at the level of the orbicular muscle. The excision is followed by the suspension of the orbicular muscle from the superior periosteum. A closure is then performed in two layers.
The possible disadvantages of this procedure include, a scar that may be difficult to camouflage and the possible interruption of the fine hairs of the eyebrow, leading to a “plucked” or “effeminate” appearance.
BIPLANE LIFT OF THE EYEBROWS
Tirkanits and Daniel describe a lift that involves a subgaleal plane for the coronal part of the dissection and a subcutaneous plane anterior to the hair implant line. The connection between the two planes is divided at the level of the hair implant line.14 In 1995, Ramirez described a biplane lift of the eyebrows using endoscopy. His technique consists in the transition of a subcutaneous dissection until the subperiosteal/subtemporoparietal fascia, which covers almost half of the area of the eyebrow.
LIFTING OF THE EYEBROWS BY MEANS OF TRANSBLEPHAROPLASTY
This procedure is performed starting from a superior belapharoplasty skin fold. Superiorly, the dissection plane is made below the orbicular muscle. The corrugated muscles and the procerus can be cauterized or divided using this procedure. The orbicular muscle e suspended until the frontal periosteum without the removal of any excess skin.
TRYCOPHYTIC LIFT THROUGH THE USE OF ENDOSCOPY
This lift is a combination of thee classical of trycophytic lift and the brow lift suing endoscopy. It offers the benefits of reduced numbness and the use of endoscopy to obtain more comprehensive release of the marginal arch. Also, it makes the direct excision of the skin in the trycophytic lift possible. This technique can also enable the excision of the bald skin between the frontal and temporal wisps of hair and reduces the appearance of a receding hair implant line.
The procedure starts with an incision of along the frontal hair implant line and continues along the temporal line. A subcutaneous plane is developed, preserving the sensory nerves, for approximately 2cm. when the frontalis is then actually divided, exposing the periosteum. The dissection then becomes subperiosteal and is carried out in the same way as an endoscopic lift. Once the marginal arch has been separated, the coetaneous remnants are once again covered and the excess skin is removed from below the trycophytic incision. The eyebrow is suspended in the same way as in the classical endoscopy technique.
There are a myriad number of procedures, for the rejuvenation of the aging face and the eyebrows, available to the facial plastic surgeon. The selection process should be based on the anatomy of the patient, where careful attention is given to the hair implant line. The plastic surgeon’s skills in respect of the different procedures described here, will result in the harmonizing the patient’s pre-existing anatomy, the aesthetic purpose and objectives< Previous