Suture suspension brow-lifting: The Minitac system

As their face ages, a significant number of individuals require elevation of the eyebrows to improve brow-ptosis and pseudo-ptosis of the upper eyelids. This may be for functional disability, i.e. when there is a reduction in visual fields, or for purely cosmetic reasons. Eyebrow elevation can be achieved by non-surgical or by direct surgical methods. There are advantages and disadvantages to the non-surgical use of Botulinum Toxin or fillers, and minimally invasive techniques such as endoscopic methods or Endotine® fixation. Bicoronal brow lift procedures appear to be reducing in popularity compared to the other methods. Suture suspension of the brow is not new but recently Minitac®, a kit system that allows intra-osseous fixation using two non-absorbable paired needle sutures, has been introduced. Whilst this system was primarily developed for ligament to bone approximation, we demonstrated in this mini-series that it can be adapted to provide a simple and effective means for brow lifting, whilst controlling the vectors of elevation. Due care and the understanding of anatomy are essential.