The Temporal Sequence of Periosteal Attachment after Elevation

Sean Boutros, MD, Robert W. Bernard, MD, Robert D. Galiano, MD, Tomaso Addona, BS, Barry Stokes, MD, and Joseph G. McCarthy, MD
Plastic and Reconstructive Surgery
2003 May; 111(6): 1942-7

This paper sheds further light on the issue of periosteal fixation and reattachment (healing) after browlift. The study examined periosteal adherence to bone after elevation to elucidate the timing of healing sequences at the bone-periosteal interface. Scalp flaps were raised on a series of guinea pigs, and mechanical and histologic testing and analysis was carried out at time points ranging from 3 to 90 days postoperatively.

The study demonstrated that healing of the bone-periosteal interface occurs at a rate similar to that of other wounds, and recommended that periosteum “be reattached by a fixation technique that will remain stable for a minimum of 30 days to allow adequate adherence between the bone and periosteum at the postoperative elevated brow position.”

This emphasis on extended fixation (30 days) as opposed to limited (10-14 days or less) is encouraging, given the ENDOTINE Forehead device’s ability to provide secure fixation for a minimum of 60 days.

Anchor Subperiosteal Forehead Lift: From Open to Endoscopic (Discussion)

James M. Stuzin, M.D., Thomas J. Baker, M.D., and Tracy M. Baker, M.D.
Plastic and Reconstructive Surgery.
2001 Mar; 107(3):872-3

Summary:

• Major difficulty in endoscopic Browlifting is fixation
• Disappointed with percutaneous screws
• Secure fixation is vital to predictability in endoscopic Browlifting

  Excerpt:
  Regarding plastic surgery, in our opinion, endoscopic Browlifting has proven to be a major advance in aesthetic rejuvenation of the aging face. At the forefront of developing endoscopic surgery in the United States, Dr. Ramirez has made many contributions that have enabled plastic surgeons today to perform endoscopic foreheadplasty safely, obtaining predictable results using this procedure.

  The advantages of endoscopic Browlifting go beyond the limited access incision and the associated decreased incidence of alopecia resulting from the shorter scar. There is also the added advantage of not dividing the deep branch of the supraorbital nerve, producing a lower incidence of numbness and postoperative neuralgia after endoscopic techniques……..

  The major difficulty we have encountered in endoscopic Browlifting is the problem of fixation…….In our opinion, obtaining secure fixation is the key to predictability in endoscopic Browlifting, not only in terms of brow elevation, but also in terms of brow shaping.”

LBL-899-7103 Rev B