A retrospective comparison of open and endoscopic brow-lifts.

Objectives To measure and compare surgical brow elevation with open and endoscopic techniques; to compare patients who did and did not undergo an eyelid procedure in the same setting as the brow-lift; and to determine whether a learning curve exists for a successful endoscopic brow-lift procedure. Design A retrospective review of patients who underwent coronal, trichophytic, and endoscopic brow-lift surgery from January 1, 1993, to December 31, 1997 (performed by K.A.L.). We analyzed preoperative and postoperative photographs obtained from 10 to 56 months after surgery while masked to the surgical technique used. Measurements included a horizontal baseline drawn through the midpoint of the right and left medial canthi, and extended laterally across the face; the distance from the baseline to the superior border of the medial eyebrow on the right and left sides; and the distance from the baseline to the highest point of the brow on the right and left sides. A second, nonbiased observer analyzed a random sampling of patient photographs to determine the degree of interobserver variation. Setting Private facial plastic and reconstructive surgery practice. All procedures were performed in an ambulatory surgery setting. Participants We identified 125 patients (average age, 54 years) with greater than 10 months of postoperative photographic documentation. We excluded 41 patients owing to several inconsistencies between their preoperative and postoperative photographs and included 84. These patients were divided into 3 groups: those undergoing coronal, trichophytic, and endoscopic procedures. Of the patients undergoing concomitant eyelid procedures, 12 underwent upper lid blepharoplasties; 15, lower lid blepharoplasties; 16, bilateral upper and lower lid blepharoplasties; 6, periorbital laser resurfacing or chemical peel; 1, canthoplasty; and 1, ptosis repair. The endoscopic brow-lift procedure was not performed in this facial plastic surgery practice until 1995. To determine whether better results were obtained in the later half of the study, when the surgeon had more experience, this group was divided between the 14 patients who underwent the procedure from January 1, 1995, to June 30, 1996, and the 20 who did from July 1, 1996, to December 31,1997. Main Outcome Measure Comparison of preoperative photographs with postoperative 10- to 32-month follow-up photographs and with final 35- to 56-month follow-up photographs. Results We found no statistically significant difference in: the distance of the medial brow ( P = .89) or highest elevated point of the brow ( P = .93) between the coronal, trichophytic, and endoscopic groups; the distance that the medial brow ( P = .15) or the highest point of the brow ( P = .11) was raised for those patients undergoing concomitant eyelid procedures; and the distance that the medial brow ( P = .80) or highest point of the brow ( P = .79) was raised between the 2 endoscopic brow-lift groups. Interobserver variation in brow measurements was 0.1 cm or less in more than 90% of cases. Conclusions Both open and endoscopic brow-lift techniques described herein elevate the entire brow successfully. We found no statistical difference in patients undergoing concomitant eyelid procedures, and there was no identification of a "learning curve" for a successful endoscopic brow-lift with the surgical technique described.