Aesthetic and Reconstructive Brow Lift: Current Techniques, Indications, and Applications

A simple, reliable, and validated method for measuring brow position

PURPOSE

To establish outcome of brow suspension techniques, a reliable and clinically suitable measurement tool is required. Most of the published methods lack statistical validation, and in none of the reviewed studies, the standardized photograph protocols were validated.

METHODS AND TECHNIQUES

Fifteen subjects were independently photographed by 2 different professional medical photographers. Adobe Photoshop CS5 software (San Jose, Calif) was used to perform the measurements based on interpupillary distance and medial, midpupil, and lateral reference points on the brow. To establish intrarater reliability, the photos of both photographers of the same subject were analyzed by the same researcher. To establish interrater reliability, the photos of 1 photographer were analyzed by 1 researcher, whereas the photos of the second photographer were analyzed by a second researcher. Reliability was assessed using the intraclass correlation coefficients (ICCs) and the smallest detectable differences.

RESULTS

The ICCs indicated good to excellent interrater and intrarater reliability. The ICCs of the interrater reliability were lower compared with those of the intrarater reliability, although they could still be categorized as good to excellent. We found that the lateral measurements had the highest reliability, and the medial measurements, the lowest reliability.

CONCLUSIONS

The current study supports that the "en face" photographs in our database are truly standardized. The good to excellent interrater and intrarater reliability of the present method makes it a valid measuring tool.

Patient outcomes, satisfaction, and improvement in headaches after endoscopic brow-lift

IMPORTANCE

To improve preoperative counseling for patients considering endoscopic brow-lift (EBL).

OBJECTIVES

To understand patient-reported outcomes, satisfaction, and recovery after EBL surgery to improve preoperative counseling.

DESIGN, SETTING, AND PARTICIPANTS

A retrospective telephone survey of 57 patients who had EBL or EBL with concurrent rhytidectomy to assess cosmetic and functional outcomes using 47 questions.

MAIN OUTCOME AND MEASURE

Questions evaluated outcomes, satisfaction, and recovery.

RESULTS

Fifty-three patients (93%) reported the procedure was successful, and 55 patients (96%) would recommend undergoing this procedure. Forty-two (74%) were incidentally told they looked younger; 37 patients (65%) were told they looked less tired. Forty-two patients (74%) reported increased confidence. Fifty-one patients (89%) required analgesics for less than 1 week, 44 patients (77%) reported scars as unnoticeable, 54 patients (95%) reported postoperative edema lasting less than 2 weeks, 16 patients (28%) reported alopecia at an incision site, and 36 patients (63%) had some numbness. In the 16 patients who reported headaches before surgery, 8 patients (50%) reported an improvement in either frequency or intensity. Patients who underwent rhytidectomy were significantly more likely to take 2 weeks or longer to return to normal activities. No differences were noted between rhytidectomy with EBL compared with EBL alone in analgesic use, edema, numbness, alopecia, and satisfaction.

CONCLUSIONS AND RELEVANCE

Endoscopic brow-lift is well tolerated and most patients are happy with the outcome. Relying on patient-reported information helps us to better understand the surgical experience and to improve preoperative counseling.

LEVEL OF EVIDENCE

4.

Change in brow position after upper blepharoplasty or levator advancement

Brow position after blepharoplasty is somewhat controversial. Some authors insist that brow position remains unchanged after surgery. On the other hand, there is also an opinion that brow position changes after surgery.We evaluate the influence of upper blepharoplasty or correction of ptosis on brow position in East Asians. Sixty patients (120 eyes) who underwent upper blepharoplasty or levator advancement were evaluated for change in brow position. Marginal reflex distance 1, brow height from medial canthus, upper eyelid margin on midpupillary level, lateral canthus, and brow height from the center of the pupil were measured before surgery and 6 months after surgery. The distance between the upper lid margin and the brow was shortened after upper blepharoplasty or levator advancement, which could cause brow depression. Change in brow height was greater after levator advancement than after blepharoplasty. These findings might be helpful for the prediction of brow position after surgery. Our study also implies that the possibility of a change in postoperative brow position change should be explained to patients before surgery, particularly ptosis patients.