Experience with cortical tunnel fixation in endoscopic brow lift: the "bevel and slide" modification.

BACKGROUND Endoscopic brow lift has become a popular method for rejuvenation of the upper third of the face and in the treatment of functional brow ptosis. Controversy, however, remains over the optimum technique for the fixation of the forehead and brow. This paper presents a single surgeon's experience with a technical modification to McKinney's original description of paramedian cortical tunnel fixation in patients undergoing endoscopic brow lifts. PATIENTS AND METHODS A case note study of all patients who underwent a modified cortical tunnel endoscopic brow lift fixation by a single surgeon over a 4-year period (2003-2006) was undertaken. The technical modification to cortical tunnel sculpting was introduced to prevent suture associated complications which had occurred in two patients prior to the study. Brow position was maintained with 2/0 polypropylene sutures anchored through modified paramedian cortical bone tunnels. Temporal fixation of superficial parietal to the deep temporal fascia was achieved with the same suture material. RESULTS Between January 2003 and December 2006, 30 patients had endoscopic brow lifts performed for aesthetic and functional reasons. All cases were bilateral. Twenty-three patients (77%) were female and seven (23%) were male. The median age was 60 years (range: 34-76). Patient follow-up ranged from 3 to 24 months (mean: 12 months). Twelve patients (40%) had another aesthetic procedure carried out at the same time. There were no early postoperative complications (bleeding, VII nerve palsy or infection). One patient had a fixation suture removed under local anaesthetic 6 weeks postoperatively due to ongoing dysaesthesia localised to that particular suture site. A second developed significant intermittent forehead/scalp dysaesthesiae, which was treated conservatively. Notably, there were no cases of alopecia at the incision/fixation sites, relapses of brow ptosis, or troublesome scalp itching. No endoscopic cases were converted to an open/coronal brow lift procedure. DISCUSSION AND CONCLUSION Cortical tunnel suture fixation provided a simple, stable, and reproducible method of maintaining brow position in endoscopically assisted forehead/brow lift with low morbidity. Our modification introduces a refinement to the technique, which allows easy passage of the fixation suture needle and prevents exposure of suture ends, thereby minimising the risk of knot-associated complications.