Video endoscopic-assisted brow lift: comparison of the eyebrow position after Endotine tissue fixation versus suture fixation.

To improve brow ptosis and forehead rhytids, minimal invasive surgery has successfully been applied more recently. Clinical studies have revealed that inadequate fixation for anchoring a transposed released soft tissue will result in a loss of suspension of the lateral eyebrow. Therefore, we evaluated the results of eyebrow position in a series of endoscopic-assisted eyebrow lift cases by comparing broad base of fixation with an Endotine device versus conventional single-point tissue fixation with suture loop fixation of the soft forehead tissue. Between 2003 and 2005, 47 patients (12 males and 35 females, age 38.5 +/- 6.2 years)) underwent eyebrow lift and a forehead plasty. In one group, which consists of 25 patients (6 males and 19 females, age 36.5 +/- 5.1 years), soft tissue fixation of the elevated forehead was performed conventionally with one suture loop on each side that passed through the galea-periosteum and anchored to the cranial bone (bone tunnels). In the other group of 22 patients (4 males and 18 females, age 39.3 +/- 6.4 years), the elevated forehead was anchored to Endotine 3.5 version. Despite the fact that 6 months after surgery, drooping of the lateral brow position was observed, with a mean of 2.3 +/- 0.8 mm, in the overall cases 12 months after surgery, differences in the position of medial third of the eyebrow were noted between these groups. In the Endotine group, the medial third of the eyebrow portion stayed more stable at its transposed position and was in mean 1.5 +/- 0.6 mm higher compared with the suture soft-fixed group. The results confirmed that Endotine enhances soft tissue suspension by allowing better distribution of tension over multiple points over time and thereby supports re-adherence strength of the transpose medial flap forehead to the frontal bone. For minimizing a relapse of the elevated lateral eyebrow portion after adequate dissection and tissue release, suspension of the lateral soft forehead tissue is paramount. It should be located between the temporoparietalis fascia and the deep temporal fascia, with extensive tension after resection of temporal fascia window additionally supported by reabsorbable threads or gore tex sutures.