The Ideal Fixation Technique In Endoscopic Brow Lifts: Are We On the Right Track?

Goals/Purpose:  An ideal fixation technique incorporates properties of long-lasting fixation, non-palpability, and the option to retain the device postoperatively as a fully indwelling adjunct without the need for removal. It should enable the surgeon an ability to obtain dynamic feedback by allowing adjustment for symmetry intra-operatively. We propose to define these ideal characteristics and propose a description of a new technique of the endoscopic application using an absorbable-fixation system.

Methods/Technique: A retrospective chart review was conducted of an academic teaching practice's patients undergoing endoscopic brow lifts with the newly-described technique. Characteristics evaluated included operative time, incremental costs comparisons to conventional methods at various stages in technique evolution, reoperation rates, absorbability and permanence of the fixation device, anatomic and theoretic basis of suspension and reported efficacy, and the learning curve for new practicing surgeons adopting this approach. Data on 58 patients undergoing this fixation method was reviewed. Patients undergoing concomitant surgical procedures were excluded. The device consisted of a Mitek suture anchor similar to tendon insertion in hand surgery.

Results/Complications: 11 of 58 patients underwent a single-procedure endoscopic brow fixation with a Mitek suture anchor from 2005 to 2010. Mean operative time was 2.1 hours with no post-operative complications. One patient underwent a revision secondary lift at 1.5 years after the primary surgical procedure. There were no cases of implant palpability or alopecia. Economic and incremental cost analysis and complication rates of current fixation methods were reviewed and the results contrasted with the new technique.

Conclusion: In our experience, the Mitek screw anchor fixation technique incorporates the desirable properties of lasting fixation without palpability or alopecia.  Despite active operative participation by plastic surgery residents, the mean operative time was reasonable. This technique offers several attractive qualities for endoscopic brow lifts with a learning curve that can be adopted by practicing plastic surgeons at any level.