Endoscopic Forehead Lift Using Endotine(R)

Lee, Hong Ki

Abstract

Brow lift is the most effective method of brow ptosis correction. For brow lifting, suprabrow incisions have not been widely used yet because they lead to prominent scars above the eyebrow especially in orientals. Although classic brow lift using coronal scalp incisions has so far been performed as an alternative to brow lift using suprabrow incisions, it is being increasingly replaced with endoscopic brow lift due to more less postoperative complications such as scalp scars and paresthesia, However, many facial plastic surgeons may abandon this operation after initially unsatisfactory surgical outcome because the learning curve of endoscopic operation is relatively painful. Endoscopic brow lift is an effective surgical treatment that can achieve a good surgical outcome if we fully understand basic anatomical structures and the surgical principles of the operation. Release and fixation are of utmost importance in this operation. We can obtain successful postoperative results if we adequately release the retaining ligamentous attachments which anchor the facial soft tissue to the facial skeleton and the depressor muscles which retract the soft tissue inferiorly and, fix the soft tissue firmly to the facial skeleton in the elevated position. Many techniques and principles for releasing the ligaments and the muscles have been described based on anatomical knowledge. In addition to them, various fixation techniques have been developed for the past decade including using fibrin glue, internal screws or plates, external screws, absorbable screws, and cortical tunnels, but some drawbacks have been reported in these fixation techniques. The Endotine forehead device, an absorbable fixation device, was developed in order to solve the drawbacks several years ago and has since been widely used in clinical practice. Brow lift using the Endotine forehead device has several advantages over other surgical procedures. First of all, the surgical time is short because this operative procedure is simple. This operative procedure can minimize patient discomfort postoperatively. And then this device can prevent relapse of brow ptosis after surgery. We describe herein our 2-year experience with endoscopic brow lift.