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The Lateral Temporal Subcutaneous Brow Lift: A Reliable Method for Successful, Stable Brow Rejuvenation
Alan Matarasso, MD, FACS1, Darren M. Smith2.
1Manhattan Eye, Ear and Throat Hospital, New York, NY, USA, 2The Hospital for Sick Children, Toronto, ON, Canada.

Until the mid-1990's, the coronal approach constituted the preferred form of brow lifting for those surgeons that embraced the concept of brow surgery. In the mid- to late-1990's, the endoscopic brow lift was introduced. Interest next focused on improving internal fixation methods as the "open" coronal procedure, albeit successful, faded from daily practice primarily because of resistance to the lengthy incision and related disadvantages (e.g. hair loss). The ensuing years displayed more disagreement over a "uniform" technique than most other facial rejuvenation operations. After an early adoption of the endoscopic brow lift, we reconsidered this option in light of unresolved fixation techniques, concerns over longevity of its results, and inapplicability to the high-forehead patient. Here, we report our experience with an alternative approach to brow rejuvenation, the lateral subcutaneous temporal brow lift (LTL).
The procedure has evolved from a subperiosteal to a biplanar and (currently) a subcutaneous lift. The LTL is marked by designing an ellipse 4-5cm in width by 2-2.5cm in height in or at the hairline depending on hairline position, density, and patient preference. The center of the ellipse is 3.5 cm lateral to the midline. Pre-excision of the skin ellipse is performed, and wide subcutaneous dissection to below the eyebrow is achieved. Fibrin sealant is introduced to the pocket, and the wound is closed with barbed sutures. The technique does not address the corrugator or procerus musculature, but is easily combined with methods to do so. We report on a series of over 400 consecutive patients undergoing LTL with 1 to 10 year follow-up.
The patients were uniformly pleased with the results. Two patients required scar revision, and one re-do surgery was performed. Hematomas occurred in approximately 3% of patients. Two patients experienced skin ischemia and necrosis.
The LTL is a powerful method of brow elevation that allows significant brow repositioning according to individual patient requirements. Complications are rare, and execution is reliable.

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