The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Raman Malhotra - One of the best experts on this subject based on the ideXlab platform.
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direct Brow Lift and skin contraction in facial nerve palsy a switch technique
Ophthalmic Plastic and Reconstructive Surgery, 2021Co-Authors: Sonali Nagendran, Daniel Butler, Raman MalhotraAbstract:The authors present a case series of 4 patients with facial nerve palsy who underwent a direct Brow Lift to correct Brow ptosis, using the excised Brow skin as a full-thickness skin graft to correct lower eyelid skin contracture, ectropion, and retraction. Functional outcomes were measured using the validated cornea, static asymmetry, dynamic function, synkinesis (CADS) grading system and by photographic assessment of lower eyelid height via margin reflex distance. Aesthetic outcomes were measured using a published grading scale specific to eyelid skin grafts.
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revisiting the direct Brow Lift in patients with facial palsy 4 key modifications
Ophthalmic Plastic and Reconstructive Surgery, 2021Co-Authors: Daniel Butler, Sonali Nagendran, Raman MalhotraAbstract:PURPOSE The direct Brow Lift is a simple and popular technique, particularly in patients with Brow ptosis secondary to facial palsy. It provides a high degree of control in determining the degree of Brow elevation and shape achieved. However, it is arguably the least debated in terms of addressing some of its sequelae, namely the risks of a visible or indrawn scar and forehead paraesthesia. In this article, we report outcomes using four alternative principles to those outlined in current published literature. METHODS All patients undergoing a primary direct Brow Lift for Brow ptosis secondary to facial palsy between January 2015 and December 2019 under a single surgeon (R.M.) were included in the study. The technical refinements of the procedure included a W-plasty type stealth skin incision, counter-bevelling of the upper and lower incision lines, skin excision in the subcutaneous plane only with minimal excision of fat and Browpexy to the frontal periosteum through small linear puncture incisions in the frontalis. RESULTS A total of 23 patients undergoing 24 direct Brow Lifts were included in the study. The mean follow-up was 1.3 years (range 0.5-3 years). No patients reported postoperative forehead paraesthesia or Brow alopecia. One patient required a further temporal BrowLift 15 months later. Brow height was rated excellent (0-1.5 mm difference) in 71% of Brows and good (1.6-4.9 mm difference) in 14% of Brows. The average Manchester scar scale was 8.6/28. CONCLUSION The technical modifications presented substantially reduce the rates of postoperative paraesthesia, whilst achieving satisfactory aesthetic outcomes.
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periosteal fixation during subperiosteal Brow Lift surgery
Dermatologic Surgery, 2008Co-Authors: Ioannis Mavrikakis, Jeanlouis Desousa, Raman MalhotraAbstract:OBJECTIVE To report the efficacy of periosteal fixation combined with Y-to-V scalp incisions during small-incision subperiosteal forehead and Brow Lift. METHODS AND MATERIALS This is a retrospective case series of 19 patients over 12 months; 16 patients underwent bilateral and 3 unilateral surgery. Unilateral surgery was performed in patients with facial nerve palsy and was augmented with cable suspension. Superior arcus marginalis release and visualization of the supraorbital nerve was achieved using an endoscope or a transblepharoplasty approach. RESULTS All patients achieved a desirable Brow Lift and contour, with a mean Lift of 2.4±1.0 mm. The mean follow-up was 11 months. During follow-up, there was no evidence of recurrence of Brow ptosis. All patients had an improvement of the glabellar furrows. Minor complications included transient diplopia (n=1), reduced medial upper eyelid sensation (n=1), brief postoperative bleeding from one of the small-incision sites (n=1), and persistent sensory loss involving the central scalp incisions (n=2). No long-term alopecia was noted in any case. CONCLUSION Our results suggest that with periosteal fixation combined with Y-to-V scalp incisions, bone fixation is not necessary to achieve a desirable height during small-incision subperiosteal forehead and Brow Lift.
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patient and surgeon experience with the endotine forehead device for Brow and forehead Lift
Ophthalmic Plastic and Reconstructive Surgery, 2007Co-Authors: Sharmin Chowdhury, Raman Malhotra, Roger Smith, Peter ArnsteinAbstract:Purpose: To report our experience with the Endotine forehead fixation device (Coapt Systems, Palo Alto, CA, U.S.A.), a bioabsorbable fixation method for forehead and Brow Lift. Methods: Retrospective noncomparative case series of 31 patients who underwent forehead and Brow Lift surgery using the Endotine device in a single center during a 12-month period from 2004 to 2005. Results A mean Brow Lift of 2.8 mm (SD, 0.2–7.1 mm) was achieved. There were no cases of recurrence during the follow-up period of 4 months to 22 months. Problems encountered included palpability, tenderness, and numbness. In the majority of cases, these symptoms resolved within a few months and were not troublesome to the patient. Other problems included visible lumps, device mobility, and exacerbation of a high hairline. Patient satisfaction was high, with 95.3% of patients saying they were either happy or very happy with the results; 81% of patients said they would recommend the Endotine as a method of fixation. All surgeons were pleased by the Lift achieved and felt the device was easy to use. Problems reported by the surgeons included 1 dislocated device, discomfort, palpability beyond 15 months, a lack of lateral compared with central Lift, and cost. Two of the 3 surgeons are still using the Endotine device as the preferred method of fixation. Conclusions: The Endotine device is effective, safe, and easy to use, and has high patient satisfaction. Problems included numbness, tenderness, and palpability. A preference for other fixation methods was indicated by some because of cost, length of surgery, and the amount of Lift achieved.
Rod J Rohrich - One of the best experts on this subject based on the ideXlab platform.
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endoscopic temporal Brow Lift surgical indications technique and 10 year outcome analysis
Plastic and Reconstructive Surgery, 2019Co-Authors: Rod J Rohrich, Minjeong ChoAbstract:Background:Brow-Lift techniques have evolved from the most invasive approach, such as a coronal Brow Lift, to a minimally invasive technique, such as an endoscopic Brow Lift over the past century. Although an endoscopic Brow Lift offers the advantage of being minimally invasive, it suffers from a hi
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Brow Lift in facial rejuvenation a systematic literature review of open versus endoscopic techniques
Plastic and Reconstructive Surgery, 2011Co-Authors: Darrell W Graham, Justin Heller, Jonathan T Kirkjian, Timothy S Schaub, Rod J RohrichAbstract:Background: Currently, there are many well-described surgical approaches to address Brow aesthetics (i.e., open versus endoscopic versus combination techniques). Each technique has associated benefits and limitations. The authors' discussion in this article is intended to review current worldwide surgical approaches to Brow aesthetics and to explore the following question: Are open Brow Lifts still pertinent in the modern era of cosmetic surgery? Methods: A systematic review of current available literature for the dates 1992 until the present was performed using the MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, and CINAWL databases. Inclusion criteria required that individual studies contain original content; provide patient outcome data, including complications; and maintain a sufficient sample size of no fewer than 20 patients. Results: One hundred eighty-nine articles were reviewed from the initial keyword searches of four major databases and plastic surgery journals. Fifteen articles were included in the analysis after careful review established that the necessary criteria were met. From direct analysis of these articles, no clear evidence exists to indicate that open methods of Brow surgery are inferior to endoscopic approaches. Conclusions: Brow-Lift surgery has clearly evolved since the inception of endoscopic techniques in the early 1990s. However, currently there are no prospective randomized trials in the literature that compare the surgical outcomes of differing approaches. This thorough review of current worldwide English-language literature highlights the relative paucity of good comparative studies and serves as a reminder that there is still an important role for the open approach to Brow aesthetic dilemmas. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Corey S Maas - One of the best experts on this subject based on the ideXlab platform.
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temporal Brow Lift using botulinum toxin a
Plastic and Reconstructive Surgery, 2000Co-Authors: Min S Ahn, Michael Catten, Corey S MaasAbstract:The objective of this study was to determine whether Brow elevation occurs as a result of paralysis of Brow depressors after botulinum toxin A injection. The study's design was a prospective case series with pretreatment and posttreatment outcome evaluation with statistical analysis at a university-based division of facial plastic surgery private clinic. Twenty-two patients of a consecutive sample desiring a cosmetic enhancement underwent injection of botulinum toxin A directed to Brow depressors. Injections consisted of 7 to 10 units of botulinum toxin A (Botox, Allergan, Irvine, Calif.) into selected Brow depressor muscle (lateral orbicularis oculi) bilaterally. No patients withdrew for adverse effects. All patients were evaluated 2 weeks after treatment. The outcomes were measured by change in Brow elevation along vertical axis extending from both midpupil and lateral canthus to the caudal row of Brow hairs with eyes at neutral gaze and the head at Frankfort plane. Preintervention and postintervention Brow height was measured by the primary clinical investigator. The average Brow elevation from the midpupil observed after selected injection of Brow depressors with botulinum toxin A was 1.02 mm (p = 0.038). The average Brow elevation from the lateral canthus observed after selected injection of Brow depressors with botulinum toxin A was 4.83 mm (p<0.0001). Significant temporal Brow elevation occurs as the result of paralysis of Brow depressors by using botulinum toxin A injection. This procedure may be considered an alternative to surgical Brow elevation.
Barry M Jones - One of the best experts on this subject based on the ideXlab platform.
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the impact of endoscopic Brow Lift on eyeBrow morphology aesthetics and longevity objective and subjective measurements over a 5 year period
Plastic and Reconstructive Surgery, 2013Co-Authors: Barry M JonesAbstract:BACKGROUND The longevity of a Brow Lift, its morphology, and its contribution to overall facial aesthetics have not been addressed in previous studies using both objective measurements and validated subjective aesthetic scoring systems. METHODS Thirty-one patients with a 5.4-year follow-up after subperiosteal endoscopic Brow Lift were assessed by (1) objective measurements using computer software, (2) validated regional aesthetic scoring systems, and (3) global aesthetic scoring systems. RESULTS In part 1, objective measurements confirm a subtle elevation of the Brows at less than 5 mm (p<0.001) that persisted at 5.4 years after surgery in all areas except the tail of the eyeBrow. In part 2, subjective regional aesthetic scoring indicated that the dimensional change is small but apparent to observers, and is maintained at 5.4 years; that depressor muscle resection with a Brow Lift provides a statistically significant reduction in glabellar lines, which is maintained at 5.4 years; and that a Brow Lift provides temporary improvement in forehead lines but that this improvement relapses to baseline at 5.4 years. In part 3, global aesthetic scores suggest that 64 percent patients are still judged as appearing better 5.4 years after a Brow Lift than before surgery. CONCLUSIONS This is the first study to provide evidence from both objective measurements and validated subjective aesthetic scoring systems regarding the morphology, benefits, and longevity of endoscopic Brow-Lift surgery. This demonstrates that a Brow Lift produces a subtle elevation, with a natural eyeBrow morphology close to the original, and with minimal long-term relapse except at the tail of the eyeBrow. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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endoscopic Brow Lift a personal review of 538 patients and comparison of fixation techniques
Plastic and Reconstructive Surgery, 2004Co-Authors: Barry M Jones, Rajiv GroverAbstract:Since the introduction of endoscopic Brow Lifting in the mid-1990s, it has become widely accepted as a method for rejuvenation of the upper third of the face. Despite the multitude of Brow fixation techniques, there are few long-term studies providing accurate analysis of outcome. The aims of this investigation were to evaluate the long-term objective results of endoscopic Brow Lifting and to establish whether the technique of fixation altered the longevity of aesthetic outcome. The outcome of endoscopic Brow Lifts carried out on 538 consecutive patients over a 6-year period was assessed. For each patient, midpupil-to-Brow distance was measured preoperatively and at intervals postoperatively. Two different fixation methods were compared: fibrin glue (n = 189, group 1; 104 records available) and polydioxanone sutures tied through bone tunnels (n = 349, group 2; 220 records available). In 214 patients, an upper lid blepharoplasty was performed simultaneously (85 in group 1 and 129 in group 2). At 1 month postoperatively, each fixation technique had produced a significant change in mean pupil to Brow height (5.93 mm in group 1 and 6.21 mm in group 2, with no significant difference between the two methods; p = 0.17). However, when measurements were compared more than 3 months postoperatively (mean, 9.4 months), there was a significant difference, with some relapse in the patients treated with fibrin glue (p 0.3 in group 1, p > 0.4 in group 2). Complications were few in both groups. In group 1, there was one infection, two instances of significant alopecia (both temporary), and one reoperation for relapse. In group 2, four patients required minor surgical revision of a lateral port scar and three minor areas of temporal alopecia, which recovered in less than 3 months. One patient had a paresis of the frontal branch that had recovered after 4 months. The endoscopic Brow Lift is therefore a safe and effective technique for increasing mean pupil to Brow height. Fixation with polydioxanone sutures tied through bone tunnels produces a significantly more stable result than fibrin glue, without greater risk. This lends weight to experimental evidence that periosteal fixation must be maintained for at least 6 weeks to be secure.
Valerio Cervelli - One of the best experts on this subject based on the ideXlab platform.
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comparison among three different fixation techniques in temporal Brow Lift surgery
Journal of Craniofacial Surgery, 2015Co-Authors: Michele Pascali, Anna Avantaggiato, Ilaria Bocchini, Francesco Carinci, Valerio CervelliAbstract:Introduction The eyeBrow Lifting with temporal approach is an increasing widespread technique. Many surgical procedures are described, but the long-term stability is dependent on the effectiveness in the fixation of elevated tissues. The authors compared 3 different fixation techniques in temporal Brow Lift. Methods Forty-five consecutive patients aged between 33 and 70 underwent Brow Lift surgery with temporal approach. Patients were divided into 3 groups; in group 1, anchorage was performed with Endotine Ribbon, group 2 with a Mersilene mesh, and group 3 with a Prolene suture. The amount of Brow elevation was assessed comparing the distance between interpupillar line and superior eyeBrow hairline, measured at the midpupil and at the lateral and medial canthal angle. The follow-up was 1 year. Results All patients had a pleasant improvement in Brow shape. The average initial Brow position was 19.84 mm near the head of the eyeBrow area, 20.74 mm at the body, and 19.57 mm in the region of the tail. A progressive recovery and a partial relapse regarding the eyeBrow body (23.88 mm at 6 months and 23.02 mm at 1 year) occurred, but overall for the lateral region, it passed from 27.53 mm at 6 months to 25.80 mm after a 12-month follow-up. Final Brow position was dependent upon surgical technique used in fixation. Discussion Different options in Brow elevation and stabilization affect the final shape and position of the Brows. From the statistical analysis, mesh suspension provided the best results in terms of long-lasting stability. Level of evidence Therapeutic III.
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an original application of the endotine ribbon device for Brow Lift
Plastic and Reconstructive Surgery, 2009Co-Authors: Michele Pascali, A Gualdi, D J Bottini, Chiara Botti, Giovanni Botti, Valerio CervelliAbstract:Background: Correction of Brow ptosis and lateral temporal laxity is one of the goals of surgical rejuvenation of the aging face. The Endotine Forehead (Coapt Systems, Inc., Palo Alto, Calif.) device is an effective bioabsorbable fixation tool for forehead and Brow-Lift procedures. However, the Endotine Forehead device alone is not able to correct lateral Brow ptosis and temporal laxity. In this article, the authors propose an innovative use of another special device, the Endotine Ribbon (Coapt Systems), to provide long-lasting results in lateral Brow-Lift surgery and temporal lateral laxity correction. Methods: Between February of 2006 and April of 2007, a total of 30 patients, aged between 38 and 70 years (average, 50 years), underwent Brow-Lift surgery. With this technique, the Endotine Ribbon is cut in halves and each portion of it is anchored to the deep temporal fascia with sutures, and its multiple tines facing outward grasp the superficial temporal fascia. The amount of Brow elevation produced was assessed by comparison of the preoperative and postoperative vertical distances between the superior eyeBrow hairline and the midpupil and lateral and medial canthal angle. The average follow-up period was 18 months. Results: Using this technique, perfectly symmetric lateral eyeBrows and temporal laxity correction were obtained in all patients. A lasting result was observed, and no significant adverse events were encountered. Conclusions: The application of the Endotine Ribbon for Brow-Lift procedures provides significant and reproducible lateral Brow elevation and temporal laxity correction. This fixation method is effective, safe, and easy to use, and leads to high patient satisfaction.
