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Preethi Srinivasan Ganapathy, Rao Chundury, Julian Perry; Frontalis muscle flap transposition as a novel technique for lateral eyebrow ptosis repair.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4740.
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Eyebrow ptosis is a significant aesthetical and functional age-related change of the upper face. We previously described anatomic variation in frontalis muscle landmarks in elderly Caucasian cadavers that may account for the pathogenesis of lateral brow ptosis; we subsequently developed a novel, minimally invasive technique to transpose a flap of lateral frontalis muscle to improve lateral brow elevation. In this study, we tested the hypothesis that the frontalis muscle flap transposition (FMFT) procedure would significantly elevate the lateral brow and substantially improve lateral eyebrow ptosis.
The charts of patients who underwent FMFT from December 2013 through September 2014 were reviewed. In brief, a 1.5cm ellipse of skin and subcutaneous tissue was first excised in the region of a lateral forehead rhytid. Blunt dissection exposed the lateral frontalis muscle and a pedicle flap was created, trimmed, and transposed laterally in a graded approach to achieve optimal eyebrow height and contour. The incision was closed with 5-0 polypropylene suture. Pre- and post-operative photos were taken of each patient, and the following parameters assessed using Image J (provided by the National Institutes of Health): corneal diameter (CD), margin reflex distance (MRD1), central brow height (CBH), medial brow height (MBH), lateral brow height (LBH), and central pupillary brow height (CPBH). Measurements were normalized to CD, and an average CD of 11.5mm was used to calculate millimeters of brow height elevation. Statistical analysis was performed using the Student’s t-test with p<0.05 considered significant.
32 total patients were analyzed; of these 27 underwent FMFT + blepharoplasty and 5 underwent FMFT alone. In the combined procedure group, there was significant increase in LBH by 1.8mm (p<0.05), CPBH by 1.76mm (p<0.05), and MRD1 by 0.91mm (p<0.01). In brows that underwent FMFT alone, there was a greater significant increase in LBH by 4.1mm (p<0.05), CPBH by 3.32mm (p<0.05), and no significant change in MRD1.
We have shown that FMFT alone results in substantial lateral brow elevation. In combination with blepharoplasty, this technique provides a less robust, yet still significant elevation in LBH. This study provides the first objective outcome measures for FMFT as a novel and effective technique for lateral eyebrow ptosis repair through a small concealed incision.
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