Brow Lift

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Dr. Weinstein uses 5 different methods for Brow Lift. The indication for brow lift is furrowing of the brow, horizontal or eleven line wrinkles in the forehead, hooding, brow ptosis and receding hair line. If there is a receding hair line an open technique in front of the hair line incision could be the best option. If the hair line is normal one of the following endoscopic or upper eyelid approach may be indicated. The brow lift with obliteration of glabellar muscles may be helpful for migraine headaches.

The ENDOTINE Forehead™ in Endoscopic Browplasty


BEFORE: A 49 year old female (Figure 1) presented with signs of facial aging and complaints of a "sad" and "tired" look. She desired a more youthful, bright appearance. On exam, she was noted to have bilateral brow ptosis.	DISCUSSION: The patient is shown at 12 weeks post-operatively (Figure 2). 5 mm of lift was obtained at the mid-pupil vertical axis and 5 mm of lift was obtained at the lateral canthal vertical axis. A pleasing shape of the lateral tail of the brow was achieved, and the patient is excited about her result. Additional experience with the ENDOTINE Forehead device has revealed that it is minimally palpable six months post-operatively.
Dr. Berkowitz commented that "The ENDOTINE device has finally rendered control for browlift procedures. We can now achieve reproducible results in a clean and efficient manner." Operative Technique:* The patient was marked, placed under general anesthesia, and prepped and draped in the supine position. Pre-operative antibiotics (1 gm of kefzol iv) were given. A series of five vertical incisions (12-14 mm in length) were made in the scalp 2 cm posterior to the hairline (one midline, two paramedian, and two temporal). Under endoscopic visualization, the periosteum was elevated off of the frontal bone and released from the supraorbital rim bilaterally. Care was taken to preserve the supratrochlear and supra-orbital nerves. The dissection was carried laterally to include the medial temporal fossa. Endoscopic graspers were used to resect the corrugator and procerus muscles. A hand drill (run at low speed) was used to create two cranial holes. ENDOTINE Forehead 3.0 devices were seated firmly against the outer bone table in each hole, and the scalp was elevated cephalad for fixation on the tines. Optimal device location is shown in Figure 3. Digital pressure was used to ensure penetration of the periosteum by the tines. The scalp incisions were closed with a single staple and a Burton’s dressing was applied to the forehead and removed after 24 hours. (Note: This patient also underwent a lower face and neck lift).
DIRECT FIXATION FOR DIRECT RESULTS The Coapt ENDOTINE TransBleph is a revolutionary new product that allows you to perform a browlift through a single, upper lid incision used for a conventional blepharoplasty. Using the Coapt patented, multipoint soft tissue fixation technology—via a small, three tined bioabsorbable implant—you now have new opportunities to help your patients regain a youthful, beautiful appearance around the eyes, without undergoing a complete forehead lift. Closer is better The ENDOTINE TransBleph is placed underneath the brow and anchored directly to the underlying bone for secure brow elevation, with minimal subperiosteal dissection required. Bleph and brow, an unbeatable combination You can now achieve the combined goals of removing upper eyelid skin and repositioning of the brow in a single surgical session. No endoscope required By utilizing the upper blepharoplasty incision for access, the ENDOTINE TransBleph helps simplify the browlift procedure. No expensive endoscopic equipment is required meaning fewer instruments to set up, process and maintain. Bleph Incision. Browlift Result. The ENDOTINE TransBleph is the best of both worlds for rejuvenation surgeries: the pioneering fixation of Coapt multipoint, bioabsorbable implants, and the ability to perform two effective procedures through a single incision—without the need of general anesthesia or expensive equipment. With the TransBleph, you can now offer your patients a dynamic new combination in eye rejuvenation that is simple, quick and direct. Simple and Quick The entire procedure is performed under local anesthesia and can be completed in just minutes per side. Secure and Adjustable Our patented, multipoint design provides secure fixation and the ability to easily readjust brow height for optimal correction and position. Surgery potentially best option for severe migraine headaches University Hospitals Case Medical Center researchers provide study results at ASPS conference CLEVELAND – The disability from migraine headaches is an enormous health burden affecting over 30 million Americans. In newly released research, 79 migraine sufferers were followed for at least five years after having undergone detection of migraine "trigger sites" and surgery. The new data finds promising outcomes for treating trigger sites surgically for migraine headaches resulting in elimination of pain for those afflicted with the condition. Since the surgery, 10 of the 79 patients required additional surgeries for newly detected trigger sites and were eliminated from the final analysis. Sixty-one of the remaining 69 patients (88 percent) have maintained the initial positive response to the surgery. Twenty patients (29 percent) reported elimination of migraines entirely, 41 patients (59 percent) noticed a significant decrease, and only eight patients (11 percent) experienced less than 50 percent improvement or no change. This new data provides strong evidence that surgical manipulation of one or more migraine trigger sites can successfully eliminate (cure) or reduce the frequency, duration, and/or intensity of migraine headaches with lasting results. Bahman Guyuron, MD, Chairman of Plastic Surgery at University Hospitals Case Medical Center and Case Western Reserve University School of Medicine, and an internationally recognized leader in the field of plastic surgery, will present new five-year research data that could potentially reveal a cure for migraine headaches on October 24, 2009, at the American Society of Plastic Surgeons annual meeting in Seattle. "Migraine headaches are extremely disabling and this surgical option offers hope for migraine sufferers," says Dr. Guyuron. "Combined with the previous studies, this new five-year data has provided strong evidence that severe migraine headaches and their painful symptoms can be successfully treated with surgery with lasting results." The impetus behind Dr. Guyuron's eight migraine headache research projects was his observation close to a decade ago that many patients who had undergone forehead rejuvenation noticed a disappearance in migraine symptoms following surgery. For patients who suffer frontal migraine headaches, Dr. Guyuron removes the corrugator supercilii (frowning) muscle group in the forehead that is suspected to be a trigger point for headaches, compressing nerves and causing nerve inflammation. Temple migraine headaches are treated by removing a small branch of the trigeminal nerve. For those patients who suffer from occipital (back of the head) migraine headaches, a small piece of muscle encasing the nerve is removed and replace with a soft tissue flap. When the headaches are located behind eyes and are triggered by weather change, he works on the nose septum and surrounding structures. Dr. Guyruon has performed more than 1,000 of these procedures on more than 450 patients, since each patient has 2.5 trigger sites in average. Analysis of more recent results demonstrates a significantly higher elimination rate. Note: Dr. Guyaron is a member of our Maxillofacial society, we have found a number of patients that benefit from Botox as well. The procedure can be done endoscopically through minimal incisions with great aesthetic cosmetic results. Larry Weinstein, MD FACS www.docweinstein.com <http://www.docweinstein.com> www.drlarryweinstein.com <http://www.drlarryweinstein.com>

Brow Lift

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