Clinical Outcomes of Browlift Using Various Methods

Sok Joong Chung; Helen Lew

doi:10.3341/jkos.2014.55.4.473

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Chung and Lew: Clinical Outcomes of Browlift Using Various Methods

Original Article

J Korean Ophthalmol Soc 2014;55(4):473-479.

Published online: 7 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.4.473

Clinical Outcomes of Browlift Using Various Methods

Sok Joong Chung, MD, Helen Lew, MD, PhD

Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea

Address reprint requests to Helen Lew, MD, PhD Department of Ophthalmology, CHA Bundang Medical Center, #59 Yatap-ro, Bundang-gu, Seongnam 463-712, Korea, Tel: 82-31-780-5330, Fax: 82-31-780-5333 E-mail: eye@cha.ac.kr

Received 28 September 201317 October 2013 Accepted 1 March 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The present study investigated the outcomes of browlift using various surgical methods including direct browplasty, endoscopic browlift and transblepharoplasty browlift.

Methods

Twenty-eight brow ptosis cases in 19 patients were treated in the present study. The mean patient age was 67.9 ± 9.7 years, and the mean observation period was 9.0 ± 3.8 months. Nine cases were treated with direct browplasty, eight cases with endoscopic browlift and 11 cases with transblepharoplasty browlift. Photographs of patients were taken before surgery and two months, six months and on the final follow-up after surgery. The brow-to-pupil distance (BPD), brow-to-medial canthus distance (BMCD), and brow-to-lateral canthus distance (BLCD) were analyzed by the Image J Program.

Results

BPD increased 1.88 ± 0.99 mm, BMCD increased 1.06 ± 1.21 mm and BLCD increased 1.36 ± 1.17 mm in all patients six months after surgery. Regarding the change in BPD, direct browplasty increased 1.79 ± 1.29 mm, endoscopic browlift increased 1.94 ± 0.80 mm and transblepharoplasty browlift increased 1.90 ± 0.94 mm without significant difference among the groups on the final follow-up. In terms of brow shape, direct browplasty effectively elevated the lateral brow and endoscopic browlift effectively elevated the medial brow compared to other procedures. No significant complications were observed in any patient.

Conclusions

Browlift techniques such as direct browplasty, endoscopic browlift and transblepharoplasty browlift are safe and effective surgical methods to correct brow height and shape in patients with brow ptosis without any significant complications.

Keywords: Brow ptosis, Direct browplasty, Endoscopic browlift, Transblepharoplasty browlift

References

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2. Goldberg RA, Lew H. Cosmetic outcome of posterior approach ptosis surgery (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc. 2011; 109:157–67.

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4. Nahai FR. The varied options in brow lifting. Clin Plastic Surg. 2013; 40:101–4.

5. Terella AM, Wang TD. Technical considerations in endoscopic brow lift. Clin Plast Surg. 2013; 40:105–15.

6. Costantino PD, Hiltzik DH, Moche J, Preminger A. Minimally invasive brow suspension for facial paralysis. Arch Facial Plast Surg. 2003; 5:171–4.

7. Rohrich RJ, Beran SJ. Evolving fixation methods in endoscopi-cally assisted forehead rejuvenation: controversies and rationale. Plast Reconstr Surg. 1997; 100:1575–82.

8. Sclafani AP. Comprehensive periorbital rejuvenation with resorb-able endotine implants for trans-lid brow and midface elevation. Facial Plast Surg Clin North Am. 2007; 15:255–64.

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Figure 1.

Schematic picture of the clinical parameters for the brow position measured in this study. The brow-to-pupil distance (BPD), brow-to-medial canthus distance (BMCD), brow-to-lateral canthus distance (BLCD), brow fat span (BFS), tarsal platform show (TPS) and interpalpebral fissure (IPF), were analyzed by the Image J Program.

Figure 2.

Comparison of clinical outcomes of brow position from patients with browptosis, before and after direct browplasty, endoscopic browlift and transblepharoplasty browlift with Endotine®. BPD = brow-to-pupil distance; BLCD = brow-to-lateral canthus distance; BMCD = brow-to-medial canthus distance.

Figure 3.

Comparison of time course of brow position from patients with browptosis, before and after direct browplasty, endoscopic browlift and transblepharoplasty browlift with Endotine®. BPD = brow-to-pupil distance; BLCD = brow-to-lateral canthus distance; BMCD = brow-to-medial canthus distance.

Figure 4.

Patients’ photos before and after various browlift surgeries. Direct browplasty: case of 70-year-old male patient (A: Before; B: After), endoscopic browlift: the case of 72-year-old female patient (C: Before; D: After), transblepharoplasty browlift with Endotine®: the case of 61-year-old female patient (E: Before; F: After).

Table 1.

Clinical outcomes of brow ptosis patients treated with direct browplasty (n = 9)

(mm)	Pre	Post 2 months	Difference	p-value^*	Post 6 months	Difference	p-value^*
BPD	29.30 ± 5.12	31.27 ± 4.74	1.97 ± 1.45	0.011	31.10 ± 4.88	1.79 ± 1.29	0.008
BLCD	29.12 ± 3.85	30.83 ± 3.93	1.72 ± 1.17	0.011	30.55 ± 4.05	1.44 ± 1.35	0.021
BMCD	30.39 ± 5.45	31.84 ± 4.48	1.44 ± 1.23	0.015	31.21 ± 4.71	0.81 ± 1.19	0.110
MRD₁	1.34 ± 1.00	2.18 ± 1.09	0.84 ± 0.38	0.008	2.00 ± 1.02	0.66 ± 0.30	0.008
MRD₂	2.92 ± 1.38	3.16 ± 1.19	0.24 ±0 .41	0.139	3.12 ± 1.24	0.20 ± 0.46	0.139
IPF	4.26 ± 2.23	5.34 ± 2.06	1.08 ± 0.51	0.008	5.12 ± 2.15	0.87 ± 0.50	0.008

Values are presented as mean ± SD; Difference (Diff, mm) was defined as Post -Pre (mm).

BPD = brow to pupil distance; BLCD = brow-to-lateral canthus distance; BMCD = brow-to-medial canthus distance; MRD1 = marginal limbal distance of the upper eyelid; MRD2 = marginal limbal distance of the lower eyelid; IPF = interpalpebral fissure.

^* Wilcoxon's signed-ranks test.

Table 2.

Clinical outcomes of browptosis patients treated with endoscopic brow lift (n = 8)

(mm)	Pre	Post 2 months	Difference	p-value^*	Post 6 months	Difference	p-value^*
BPD	25.52 ± 3.82	27.80 ± 4.20	2.29 ± 0.97	0.012	27.46 ± 4.14	1.94 ± 0.80	0.015
BLCD	26.93 ± 3.27	28.76 ± 3.44	1.83 ± 1.07	0.017	28.34 ± 3.63	1.41 ± 0.92	0.020
BMCD	26.44 ± 3.78	27.61 ± 3.47	1.18 ± 1.61	0.050	27.89 ± 4.50	1.46 ± 1.66	0.036
MRD₁	1.26 ± 0.65	2.50 ± 0.80	1.24 ± 0.58	0.012	2.46 ± 0.79	1.20 ± 0.60	0.012
MRD₂	2.86 ± 0.82	3.51 ± 1.08	0.65 ± 0.88	0.208	3.59 ± 1.29	0.73 ± 0.92	0.123
IPF	4.12 ± 1.19	6.02 ± 1.31	1.89 ± 1.20	0.012	6.05 ± 1.70	1.93 ± 1.34	0.015

Values are presented as mean ± SD; Difference (Diff, mm) was defined as Post -Pre (mm).

BPD = brow-to-pupil distance; BLCD = brow-to-lateral canthus distance; BMCD = brow-to-medial canthus distance; MRD1 = marginal limbal distance of the upper eyelid; MRD2 = marginal limbal distance of the lower eyelid; IPF = interpalpebral fissure.

^* Wilcoxon's signed-ranks test.

Table 3.

Clinical outcomes of browptosis patients treated with transblepharoplasty browlift with Endotine® (n = 11)

(mm)	Pre	Post 2 months	Difference	p-value^*	Post 6 months	Difference	p-value^*
BPD	24.21 ± 4.86	26.21 ± 5.17	2.00 ± 0.62	0.003	26.11 ± 5.38	1.90 ± 0.94	0.003
BLCD	25.08 ± 4.71	27.17 ± 4.89	2.10 ± 1.36	0.003	26.35 ± 5.00	1.28 ± 1.28	0.004
BMCD	25.60 ± 4.56	27.32 ± 4.44	1.72 ± 1.19	0.003	26.57 ± 4.53	0.98 ± 0.82	0.004
MRD₁	1.73 ± 0.66	2.57 ± 0.50	0.84 ± 0.36	0.003	2.64 ± 0.65	0.91 ± 0.46	0.003
MRD₂	3.98 ± 0.99	4.24 ± 0.84	0.25 ± 0.49	0.168	4.04 ± 0.67	0.06 ± 0.50	0.790
IPF	5.71 ± 1.50	6.80 ± 1.14	1.09 ± 0.75	0.004	6.68 ± 1.18	0.97 ± 0.81	0.006

Values are presented as mean ± SD; Difference (Diff, mm) was defined as Post -Pre (mm).

^* Wilcoxon's signed-ranks test.

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