Minimally invasive brow suspension for facial paralysis.

OBJECTIVE To report a new technique for unilateral brow suspension for facial paralysis that is minimally invasive, limits supraciliary scar formation, does not require specialized endoscopic equipment or expertise, and has proved to be equal to direct brow suspension in durability and symmetry. DESIGN Retrospective survey of a case series of 23 patients between January 1997 and December 2000. SETTING Metropolitan tertiary care center. PATIENTS Patients with head and neck tumors and brow ptosis caused by facial nerve paralysis. MAIN OUTCOME MEASURE The results of the procedure were determined using the following 3-tier rating system: outstanding (excellent elevation and symmetry); acceptable (good elevation and fair symmetry); and unacceptable (loss of elevation). RESULTS The results were considered outstanding in 12 patients, acceptable in 9 patients, and unacceptable in only 1 patient. One patient developed a hematoma, and 1 patient required a secondary adjustment. CONCLUSIONS The technique has proved to be superior to standard brow suspension procedures with regard to scar formation and equal with respect to facial symmetry and suspension. These results have caused us to abandon direct brow suspension and to use this minimally invasive method in all cases of brow ptosis due to facial paralysis.