Know surgical options for brow ptosis

Baltimore-Optimal results from surgical correction of brow ptosis depend on a thorough knowledge of available procedures and the results each of these will have on brow shape and symmetry, said Dan Georgescu, MD, PhD, here at the 23rd annual Current Concepts in Ophthalmology meeting, held in association with Ophthalmology Times.

"Brow ptosis is a common finding in patients with dermatochalasis. If not addressed at the time of upper blepharoplasty, it can result in poor functional and cosmetic outcomes," said Dr. Georgescu, who is with the Wilmer Eye Institute at Columbia, Columbia, MD. He specializes in cosmetic and reconstructive procedures of the eyelids and face, orbit, and lacrimal system.

Dr. Georgescu has focused his research on developing new surgical techniques, particularly for brow lift and eyelid surgery. Recently, he conducted a study to compare the outcomes of five popular brow-elevating techniques:

For each patient, both pre- and postop measurements included the distance from a horizontal line through the center of the pupils to the tip of the medial brow, the upper arch of the central brow, and the upper arch of the lateral brow.

Surgical technique

For internal brow sculpting, internal brow sculpting plus brow pexy, and internal brow sculpting plus corrugator/depressor supercili removal, Dr. Georgescu uses the upper eyelid blepharoplasty approach.

"This approach is convenient and offers several advantages, including good visualization of the structures," Dr. Georgescu said. "It also requires no additional incisions, offers faster recovery time, decreases operative time and costs, and can be done under local anesthesia."

Best medial and lateral results

Upon completion of the study, Dr. Georgescu found that different approaches were optimal for overall, medial, or lateral lifting.

Overall results seemed to be worst with blepharoplasty alone, which led to a 2-mm decrease in the position of the brow medially, centrally, and laterally. This was no surprise, he said, because similar results have been reported in previous studies. For the medial brow, a different approach gave optimal results.

"Internal brow sculpting with corrugator/depressor supercili removal and the endoscopic forehead lift were the most potent procedures for lifting the medial brow," he said. "The same thing happens with the central brow."

He also found that brow pexy was slightly more effective than internal brow sculpting alone for lifting the medial brow.

Laterally, two procedures provided optimal results.

"We found that the direct brow lift and the endoscopic forehead lift were the most effective procedures for lifting the lateral brow," Dr. Georgescu said.

"It's interesting that an internal brow sculpting with brow pexy and internal brow sculpting with corrugator/depressor supercili muscle removal achieved about two-thirds of the effect of an endoscopic forehead lift," he said. "This is very important because this procedure can be done from the upper blepharoplasty incision. It is faster and cheaper."

When pre- and postoperative differences between the lateral and medial brows were examined, Dr. Georgescu concluded that all procedures decreased the amount of brow asymmetry, although the endoscopic forehead lift seems to be the most effective procedure for doing so.