Periosteal fixation during subperiosteal brow lift surgery.

Objective: To report the efficacy of periosteal fixation combined with Y-to-V scalp incisions during small-incision subperiosteal forehead and brow lift.

Methods And Materials: This is a retrospective case series of 19 patients over 12 months; 16 patients underwent bilateral and 3 unilateral surgery. Unilateral surgery was performed in patients with facial nerve palsy and was augmented with cable suspension. Superior arcus marginalis release and visualization of the supraorbital nerve was achieved using an endoscope or a transblepharoplasty approach.

Results: All patients achieved a desirable brow lift and contour, with a mean lift of 2.4 +/- 1.0 mm. The mean follow-up was 11 months. During follow-up, there was no evidence of recurrence of brow ptosis. All patients had an improvement of the glabellar furrows. Minor complications included transient diplopia (n=1), reduced medial upper eyelid sensation (n=1), brief postoperative bleeding from one of the small-incision sites (n=1), and persistent sensory loss involving the central scalp incisions (n=2). No long-term alopecia was noted in any case.

Conclusion: Our results suggest that with periosteal fixation combined with Y-to-V scalp incisions, bone fixation is not necessary to achieve a desirable height during small-incision subperiosteal forehead and brow lift.