ENDOSCOPIC BROW-LIFT

ENDOSCOPIC BROW-LIFT ENDOSCOPIC BROW-LIFT is suitable for patients who have developed droop (ptosis) of the brow. The procedure can contribute to the treatment of deep transverse forehead wrinkles. It is effective for correction of the forehead deformity associated with unilateral facial palsy. The operation can also help to improve the results after short scar face-lift surgery. The operation aims to lift the forehead and eradicate any downward pull on the brow. The desired amount and direction of lift, and the effect that the change eyebrow position has upon the balance of the face is critical. Careful planning is needed before surgery can be considered. For a significant number of patients isolated forehead wrinkles can be treated using Botox injections rather than surgery. Some wrinkles will respond to micro-fat injection. Some patients will be better served by a procedure to the upper eye-lid or by a temporal lift (merely lifting the lateral portion of the eyebrow.) Surgery is under general anaesthetic. Four incisions are made 1.5 cm behind the hairline. Two incisions are 5cm lateral to the midline, and a further two incision are placed in the hair bearing scalp each side of the head, on a axis from the nasal sulcus (the lateral border of the nostril) to the lateral canthus (most lateral point of the eye).. A 70 degree angled, 4 mm diameter, endoscope (surgical telescope) is used to allow dissection under the forehead muscle over the bone of the forehead as far as the orbital rim. This also allows dissection from the lateral temple to the middle of the forehead (through the “zone of adherence” in the lateral forehead.) The surgery usually lasts less than one hour. The procedure may be combined with surgery to eyelids or with a face-lift. The wounds are closed with a combination of staples and sutures. Patients should expect bruising and swelling around the eye in the first few days after surgery. The lifted brow is held in position using two sutures anchored to the top of the head. Clips are used to close the scalp wounds and are removed from at approximately 12 days. This is not a particularly traumatic experience, and is done in out patients. The wounds usually heal without problems, for men baldness is itself not a contraindication to surgery. RISKS are associated with all surgery including infection, bleeding and prolonged swelling. Risks particular to this operation include over and under correction of the eyebrow position, damage to the sensory nerves of the forehead, and damage to the motor nerve to the forehead muscles, disruption or movement of the anchoring sutures, prolonged headaches, and early recurrence of the problem. Hair loss around the surgical scars has been reported. The effect of surgery is to some extent variable. This technique has been used since the mid-nineties. The consensus opinion among surgeons performing the operation is that for most patients the effect lasts between 5 and 10 years.