MicroAire

The Endotine Forehead™ in Endoscopic Browplasty

Background: R. Laurence Berkowitz, MD trained in General and Plastic Surgery at the University of Michigan Medical Center, and has held appointments as Assistant Professor of Surgery at Stanford University and as Director of the Burn Unit at Santa Clara Valley Medical Center. He is board certified by the American Board of Plastic Surgery and currently operates a busy cosmetic surgery practice in Campbell, CA. An early adopter of endoscopic surgery techniques, Dr. Berkowitz has performed over 450 endoscopic browlifts since 1993, and has used the ENDOTINE Forehead device exclusively in more than 100 endoscopic browplasty cases since March 2002.
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BEFORE: A 49 year old female (Figure 1) presented with signs of facial aging and complaints of a “sad” and “tired” look. She desired a more youthful, bright appearance. On exam, she was noted to have bilateral brow ptosis.
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DISCUSSION:The patient is shown at 12 weeks post-operatively (Figure 2). 5 mm of lift was obtained at the mid-pupil vertical axis and 5 mm of lift was obtained at the lateral canthal vertical axis. A pleasing shape of the lateral tail of the brow was achieved, and the patient is excited about her result. Additional experience with the ENDOTINE Forehead device has revealed that it is minimally palpable six months post-operatively.
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Dr. Berkowitz commented that “The ENDOTINE device has finally rendered control for browlift procedures. We can now achieve reproducible results in a clean and efficient manner.”
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Operative Technique:* The patient was marked, placed under general anesthesia, and prepped and draped in the supine position. Pre-operative antibiotics (1 gm of kefzol iv) were given. A series of five vertical incisions (12-14 mm in length) were made in the scalp 2 cm posterior to the hairline (one midline, two paramedian, and two temporal). Under endoscopic visualization, the periosteum was elevated off of the frontal bone and released from the supraorbital rim bilaterally. Care was taken to preserve the supratrochlear and supra-orbital nerves. The dissection was carried laterally to include the medial temporal fossa. Endoscopic graspers were used to resect the corrugator and procerus muscles. A hand drill (run at low speed) was used to create two cranial holes. ENDOTINE Forehead 3.0 devices were seated firmly against the outer bone table in each hole, and the scalp was elevated cephalad for fixation on the tines. Optimal device location is shown in Figure 3. Digital pressure was used to ensure penetration of the periosteum by the tines.

The scalp incisions were closed with a single staple and a Burton’s dressing was applied to the forehead and removed after 24 hours. (Note: This patient also underwent a lower face and neck lift).

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* Please refer to the ENDOTINE Forehead Instructions for Use prior to using the device.