In the JournalsPerspective

External browpexy a minimally invasive alternative to temporal brow suspension

External browpexy was demonstrated to be a viable alternative to internal browpexy in the enhancement of subjective outcomes after blepharoplasty, according to a study.

The procedure is designed to lift or stabilize the temporal brow during upper blepharoplasty surgery.

“The external browpexy is a minimally invasive, quick and simple temporal brow suspension that can be added to blepharoplasty to enhance results,” the study author said. “The proce­dure is offered as an alternative to standard internal browpexy, which in the author’s experience has been less reliable in attain­ing these outcomes.”

The researcher retrospectively reviewed the records of 28 patients who underwent external browpexy. Average patient age was 62 years; average postoperative follow-up was 6 months.

Five patients (18%) had unilat­eral browpexy and 27 (96%) had browpexy in conjunction with upper blepharoplasty. Four patients (14%) pre­sented with solely cosmetic concerns; 24 patients (86%) reported visual deficits or a combination of cosmetic and functional concerns.

Study results showed no cases of cutaneous infection, suture abscess, granuloma or migration related to placement of the fixation suture. All patients reported mild pain and tenderness at the brow incision and swelling posterior to the brow fixation point in the immediate postoperative period. Pain and swelling resolved 3 to 4 weeks postoperatively. One patient had a mild scar after surgery.

All patients reported complete satisfaction with surgical outcomes, the author said.

External browpexy was demonstrated to be a viable alternative to internal browpexy in the enhancement of subjective outcomes after blepharoplasty, according to a study.

The procedure is designed to lift or stabilize the temporal brow during upper blepharoplasty surgery.

“The external browpexy is a minimally invasive, quick and simple temporal brow suspension that can be added to blepharoplasty to enhance results,” the study author said. “The proce­dure is offered as an alternative to standard internal browpexy, which in the author’s experience has been less reliable in attain­ing these outcomes.”

The researcher retrospectively reviewed the records of 28 patients who underwent external browpexy. Average patient age was 62 years; average postoperative follow-up was 6 months.

Five patients (18%) had unilat­eral browpexy and 27 (96%) had browpexy in conjunction with upper blepharoplasty. Four patients (14%) pre­sented with solely cosmetic concerns; 24 patients (86%) reported visual deficits or a combination of cosmetic and functional concerns.

Study results showed no cases of cutaneous infection, suture abscess, granuloma or migration related to placement of the fixation suture. All patients reported mild pain and tenderness at the brow incision and swelling posterior to the brow fixation point in the immediate postoperative period. Pain and swelling resolved 3 to 4 weeks postoperatively. One patient had a mild scar after surgery.

All patients reported complete satisfaction with surgical outcomes, the author said.

    Perspective
    Charles B. Slonim, MD

    Charles B. Slonim, MD

    Massry’s minimally invasive, small-incision, external browpexy article not only reminds the blepharoplasty surgeon how important brow position is in the final surgical outcome, but also details a relatively simple procedure that benefits both the surgeon and patient. External browpexy means transcutaneous surgery which ultimately means a scar. It is hard to argue with 100% happy patients (n=28) including a woman with a subtle scar. However, readers will need to familiarize themselves with postop scar injections using a 5-FU/Kenalog combination (recipe included) because 71% of patients received these injections postoperatively. Nonetheless, that would be a small price to pay for such a high success rate for a simple brow procedure. Blepharoplasty surgeons who lose sleep over dealing with the dermatochalasis patient with a mild degree of brow ptosis will find this article relatively exciting. Massry acknowledges the need for future studies with quantitative measurements to predict more objective outcomes.

    • Charles B. Slonim, MD
    • OSN Oculoplastic and Reconstructive Surgery Board Member

    Disclosures: Dr. Slonim has no relevant financial disclosures.