Objectives: Eyebrow lifting techniques with percutaneously inserted, resorable, barbed threads are compared to surgical lifting with polyester threads, inserted through a temporal incision, guided toward the eyebrows with a cannula and back, and sutured to the temporal fascia. Considerations about indications, examples of clinical results and highlights of insertion techniques are presented.
Introduction: Percutaneous insertion of barbed threads is an interesting, minimally invasive option to lift the eyebrows, besides the use of toxin, tissue tightening with energy based devices and myomodulation by sub frontalis injections. Between surgical lifting techniques, together with transpalpebral fixation, surgical suture lifts leave notably less traces than direct excision and temporal forehead lifts. They are far less invasive than open or endoscopic forehead lift. Different patient categories are best served by the non-invasive versus the surgical option.
Materials / method: Clinical photography and patient notes were compared to define the clinical factors that influence the indications and treatment plan, and to compare the non-surgical and the surgical options. Representative film fragments were selected to explain the insertion techniques.
Results: Frontalis muscle tone frequently decreases after procedures which improve upper eyelid opening or the visual field (upper eyelid surgery or eyebrow lifting). This makes quantification of the efficacy of eyebrow lifting techniques by clinical photography very difficult. Gender-dependent aesthetic standards, the passive mobility of the eyebrow, patient expectations, the direction of eyebrow descent (inferior versus inferomedial), and associated upper eyelid surgery are determining factors for the choice of procedure.
Conclusion: Surgical eyebrow lifting with polyester sutures through a temporal incision and stab incisions at the inferior border of the eyebrow offer a reliable and durable result to patients who need an lifting of only a few millimetres. The technique is best suited for superolateral elevation of the tail of the eyebrows. It is most frequently a complement to upper blepharoplasty. Percutaneous insertion of barbed, resorbable threads can offer a light superior or superolateral lifting with a result lasting from six months to two years, depending on the resorption time.
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