Journal of Plastic, Reconstructive & Aesthetic Surgery
There are four key evolutionary phases of browlifting. the first, characterised by some form of direct excision, sequed into the understanding that muscle modification was critial to longevity. Phase III contributed the importance of adquate ligamentous release, further enhanced by the limited scars of today's endoscopic era, the improved vascularity of which permits synchronous resurfacing.
Over an 18-year period (1994-2012) the senior author (JJS) performed 810 consecutive endoscopic-assisted browlifts (EABL). Whilst subject to some procedural evolutions surgical technique remained relatively unchanged in its fundamentals:
- Three optical cavities (two temporal and one frontal):
- Arcus marginalis and lateral orbital ligamentous attachment release to enabled cephalad brow repositioning;
- Controlled posterior subperiosteal dissection;
- Attenuation of glabellar complex muscles proportionate to their degree of hyperactitvity.
EABL commences with local anaesthetic at incision sites and the glabella musculature....