Eyebrows elevation – a new, easy and cheap technique
AUTHOR: Domingos Q. De Paola, MD (*)
CO-AUTHOR: Domingos De Paola Neto (**)
CO-AUTHOR: Diana Carvalho De Paola (**)
* Plastic Surgeon Member of ASAPS – ISAPS – AACS – SBCP
** Medical Students Unigranrio University – Rio de Janeiro - Brazil
Introduction:
In the last years, all efforts has been directed to the development of alternative techniques to classical methods (forehead lifting, endoscopic lifting, Castañares technique, Aptos threads, etc) to eyebrows elevation, using small ambulatory interventions, under local anesthesia which can return the patient quickly to his social and labor activities.
Redeeming a technique published in 1967 by Dr. René Guillemain, “the Curl lift”, we find a very easy and a long lasting result procedure to elevate the eyebrows, in a fast resolution ambulatory intervention.
Goals/Purpose:
The “Curl lifting” technique for eyebrows elevation, which will be described, consists in soft tissues elevation using smooth threads tied up in the level of the hairline. The threads are inserted under the skin, in two different surgical plans in order to avoid the “undermining effect” when the threads are tied up.
This technique has the advantage of no visible scars, like the Castañares technique and the forehead lifting, easy equilibration of both sides which is difficult with Aptos threads, has a very short learning curve and is a low cost procedure, the opposite of the endoscopic techniques.
Methods/Technique:
In all cases, local infiltrative anesthesia is used: a thin needle is used to administer 1% lidocaine solution in the area of the entry and exit of the modified blunt Reverdin needle, and along its passage through soft tissues.
The pre-operatory marks are done with the patient in erect position. The first drawing is a vertical line from the most external point of the eyebrow until the hairline. The second one begins 2 cm from the first one and ends 2,5 cm from the end of the first line, in the level of the hairline. The third and fourth lines are horizontal and complete the square.
A 15’ blade scalpel is used to stab the skin in each corner of the preliminarily marked square contour. Then, through the 15’ blade's orifice, a blunt Reverdin needle is inserted through the external superior orifice in a deep plan (under the galea aponeurosis), until it goes out across the external inferior orifice and pick up the smooth thread. Then the needle returns bringing the thread. After this the needle is inserted, again, through the internal inferior orifice, in a superficial sub-dermal plan until goes out across the external inferior orifice and pick up again the smooth thread. The needle is then inserted through the internal superior orifice in the deep plan, until it goes out across the internal inferior orifice and pick up the smooth thread. And, finally, to complete the square, the needle is inserted from the first orifice (the external superior one) to pick up the thread across the internal superior orifice, using the superficial plan. After this, the thread's ends are tied up, cut and buried under the skin, using a delicate hook. We also use this hook to release any possible wrinkles formed by the elevation of soft tissues and, with this done, we can close the orifices with a 6-0 nylon stitches. The last step is a bandage with Micropore at the forehead, for three days, to immobilize the region.
It is very important before tie up the last side put the patient in sitting position to equilibrate both sides.
Results/Complications:
The routine operation is easy and quick to perform, accompanied by minimal injuries to the tissues, with the intervention's outcome manifesting itself as early as on the operating table, a short-term rehabilitation period, and complying with elementary recommendations (abstaining from abrupt mimic and excluding facial massage for three weeks). The obtained outcome proves to remain for a long time.
We are using the Curl-lifting technique for eyebrows elevation, above described, since May 2003, in more than 800 patients from 35 to 82 years (average of 58,5 years).
Conclusion:
The “Curl” lifting technique using smooth threads for eyebrows elevation is one more excellent tool in the therapeutic arsenal of ancillary procedures for the correction of facial aging. This is a minimal invasive ambulatory procedure which has as main advantages no visible scars and a short learning curve.
We think the long lasting result depends mainly at the changing plans done between the vertical and the horizontal lines on the corners of the preliminarily marked square contour.
Based in the results we achieve, after more than 800 cases using this technique, alone and associated with other procedures (face-lifting, Aptos threads for the face elevation and filling product procedures), we reach the conclusion that this technique can substitute with advantages all others surgical techniques for eyebrows elevation.
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