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T. J. McCulley, I. Phan, M. K. Yoon, T. N. Hwang; Assessment of the Effect of Ethnicity on the Cosmetic Outcome of Lateral Direct Brow Lifting. Invest. Ophthalmol. Vis. Sci. 2009;50(13):666.
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With the emergence of modern brow lifting techniques, the direct brow lift is rarely and probably under utilized. This avoidance is due primarily to fear of unacceptable scarring, particularly in more darkly pigmented individuals. The dermis of the lateral brow is thinner than medially and therefore less prone to scarring. In select patients with predominantly lateral brow ptosis, a modified lateral direct brow lift may serve as a reasonable alternative to larger caliber techniques. In this report we describe outcomes of ten patients of varying ethnic backgrounds who underwent lateral direct brow lifts.
In this retrospective case series, we reviewed 20 brows of 10 consecutive patients (4 male, 6 female; ages 61 to 77) who underwent a direct lateral brow lift. Main outcome measure was ethnicity, need for surgical revision and the development of unacceptable scarring. Surgical technique was as follows: skin incision was made with a 15-blade scapel and unipolar cautery was used to remove the desired amount of skin and partial-thickness subcutaneous fat over the lateral half of the ptotic brow. Inferior dissection within the subcutaneous fat layer allowed mobilization of the brow superiorly. Closure was performed in three layers: subcutaneous fat using interrupted 5.0 Vicryl sutures, dermis with interrupted 5.0 Vicryl sutures and skin with a running 6.0 fast-absorbing plain gut suture.
Patients were of various ethnic backgrounds: Caucasians (n=6), Latinos (n=2), Filipino (n=1), and Indian (n=1). Follow-up ranged from three to seven months. No patient required surgical revision. No patient reported or was felt by the treating physician to have unacceptable scarring. There was no difference in scar visibility in Caucasian vs non-Caucasian patients (based on patient satisfaction and surgeon review of post-operative photos). All patients had good functional and cosmetic results.
A lateral direct brow lift is a simple, minimally-invasive surgical approach that can effectively address lateral brow ptosis and associated lateral hooding. This small pilot series of patients of varied ethnic backgrounds, suggests that direct lateral brow lifting may be acceptable even in patients with various degrees of skin pigmentation.
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