Proposing an Objective Grading Scale to Assess Outcomes of Endoscopic Versus Open Brow-Lift Surgery: A 15-Year Experience of Over 200 Patients at a Single Institution
Ali Charafeddine, MD, Jeremie D. Oliver, BS, BA, Uldis Bite, MD, Samir Mardini, MD.
Mayo Clinic, Rochester, MN, USA.
PURPOSE: We propose a novel objective analysis tool to be utilized in preoperative surgical planning, as well as postoperative assessment of results over time in brow-lift surgery.
METHODS: All patients who underwent brow-lift surgery, endoscopic or open, between January 2002 and December 2017, were retrospectively reviewed. Objective measurements of medial brow (Angle A), mid brow (at the level of the lateral limbus, Angle B), and lateral brow (Angle C) vectors in relation to Cupidís bow were recorded for different time points to evaluatelongevity of objective outcomes.
RESULTS: 202 patients (145 females, 57 males; age range 18-92 years, average age=58.7 years) underwent brow-lift surgery at our institution. The endoscopic technique was utilized in 134 (66.3%) patients, while 68 (33.7%) were open procedures (coronal, n= 10, pretrichial, n=38, direct, n=18, and transpalpebral, n=2). Statistically significant shifts in lateral brow (Angle C (p<0.0001)) and mid-brow (Angle B (p<0.0001)) were found when comparing preoperative angles to postoperative angles at all time points. Open procedures were associated with astatistically significant superior mid-brow lift (Angle B at 1-week; p=0.005, and 4-6 months postoperatively; p=0.001) and lateral brow lift (Angle C at 1-week postoperatively; p=0.001)compared to the endoscopic approach. Complications analyzed included: hematoma, facial nerve injury and dehiscence, for which there was no significant difference between open and endoscopic approaches.
CONCLUSION: This is a novel objective analysis tool that can be used to assess longitudinal outcomes of functional and aesthetic brow-lift surgery.
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