Eyebrow Lifting and Reshaping with novel Polylactic acid Threads

Eyebrows: An Overview

Eyebrows are aesthetically a very important part of the upper third of the face. The shape of the eyebrows is not only aesthetically very pleasing but eye brows are an important organ of facial expression. Eyebrows are mobile structures and move in different planes, horizontally, vertically and obliquely and with complex combinations of above. These movements convey the general mood, emotions and contribute to overall facial expression.

Anatomical Considerations

Eyebrows are attached along the supraorbital ridge through its attachment to the undersurface of the eyebrow fat pad.

Eyebrow Ptosis with the Aging Process

Eyebrow shape depends on the following factors , which undergo volumetric changes with age and eventually lead to eye brow ptosis:

1. Bony shape of the orbit: The supraorbital ridge is deficient in the lateral third of the orbital rim, causing the brow ptosis to begin and be most prominent laterally in the lateral third of the eyebrow
2. Supraorbital ligament laxity: Develops with volumetric changes in the Galea fat pad and ROOF ( Retro Orbicularis Oculi Fat pad ) over which the supraorbital ligament rests on, contributing eye brow ptosis.
3. Muscular Tone and Balance: Frontalis muscle is the elevator of the eyebrows and the Orbicularis oculi muscle is the depressor of the eyebrows. The lack of muscle fibres with low muscle tone of Frontalis muscle in its lateral part contributes to eye brow ptosis.
4. Fat compartments underlying and surrounding the eyebrow: Volumetric changes in the fat pads with age and weight loss lead to lateral eye brow ptosis.

What is considered as a perfect eye brow shape

1. A line drawn from the lateral ala of the nose to the medical canthus of eye, marks the medial end of the eyebrow.
2. Another line drawn from the ala of the nose to the lateral canthus of the eye, marks the lateral extent of the eyebrow, and
3. A line drawn from the lateral limbus of the eye marks the arch or highest point of the eye brow. Classically, this shape is said to be aesthetically pleasing even though it does depend on the overall structure of the face and ethnicity.

Approach to Correcting the Lateral Eyebrow Ptosis

Eyebrow Thread lifting and Reshaping with Double needle polylactic acid threads:

Technique: A ‘V’ shaped eyebrow thread lifting technique is carried out, which allows for the lifting and reshaping of the lateral part or the tail of the eyebrow.

A word about polylactic acid sutures, they are:

1. monofilament absorbable sutures
2. are made of synthetic poly lactic acid and also caprolactone
3. Provide tissue support and lifting with no tissue trauma through a mechanism of suspension-barbs.

How do threads work:

The Polylactic acid Double needle threads are novel threads and allow for

1. Traction of the tissues resulting in lifting and reshaping of the eyebrows, and
2. Anchoring. Hence the effect of the threads after insertion is a lifting and reshaping of soft tissues on the lateral eyebrows.

Mechanism of Eyebrow Lifting and Reshaping with Polylactic Acid Threads

The suture is placed in the subcutaneous tissue with it’s associated fibrous septa. These fibrous septa are numerous and run from the skin to the musculo-aponeurotic tissue layer, deep to the subcutaneous tissue layer.

When the placement is complete the sutures are massaged upwards. With this manuveor, the suspension barbs/cones engage and stabilise themselves in the

Novel Effects of Polylactic Acid Threads

1. Immediate effect i.e. Lifting and Reshaping action, for the support and repositioning of the tissues of lateral eyebrow, and
2. Delayed effect i.e. Revitalisation action, due to fibrosis that appears along the threads and leads to skin tightening effect.

Ideal Patient for the Eyebrow Thread Lift Using Polylactic Acid Threads

1. Between 30-60 years of age
2. Minor upper eyelid skin excess
3. Moderate eyebrow Ptosis
4. Normal to thick frontal/temporal area skin.

‘V’ Shape Technique for Eyebrow Thread Lift

The procedure is carried out under aseptic conditions with using 1% lignocaine with adrenaline. The procedure is as follows :

1. We identify the safety lines
2. Identify the Entry Points
3. Identify the intermediate Lines.
4. Identify the Exit Points
5. Identify the Reshaping lines that would be the path of the threads

Recommended Post Procedure Management:

1. Short term antibiotics - the author uses clarithromycin 500 mg x twice daily for 2 days.
2. Pain Management - Usually with paracetamol or anti-inflammatory pain of choice for a few days as needed.
3. The patient is advised to : sleep face up in elevated position for 5 days, avoid vigorous massage to the face for 10 days, avoid over exposure to direct sunlight sunlight for 14 days and avoid saunas and sun beds for 3 weeks.

Side effects that usually last for about 1 week:

1. Swelling - normal and subsides spontaneously.
2. Bruising - If present, subsides in usually 1 week but may take up to 2 weeks.
3. Skin depressions and irregularities - Normal and subside gradually and spontaneously.
4. Neural Pain or Paraesthesia - Subsides with pain management
5. Asymmetry - Subsides spontaneously as the threads settle into the tissues.

Complications: Uncommon and typically last for more then 2 weeks

1. Hematoma - Very uncommon and results from a needle inadvertently puncturing a blood vessel. Prompt pressure applied for about 10 minutes prevents the complication.
2. Neural Pain or Paraesthesia after the procedure that lasts for more then 2 weeks - may be the result of over traction of the treads resulting in traction on a nerve. Conservative treatment with pain management relieves the complication but may occasionally take up to 6 week.
3. Skin Depression and irregularities that last for more then 2 weeks - May develop as the thread placement may be in a more superficial plane. Gentle massage relieves the condition.
4. Infection - Rare and treated with antibiotics and occasionally by thread removal.
5. Thread spontaneous extrusion - Treated with by simply cutting the extruding thread flush with the skin.
6. Visibility and palpability of the thread - Results from the superficial placement of the sutures and usually subsides in a few weeks. Rarely, if it is very bothersome for the patient, the thread may have to be removed.

Contra-Indications:

1. Unrealistic Expectations
2. Local or systemic infection
3. Immune disorders
4. Severe systemic illness
5. Pregnancy/Lactation