Coronal Brow Lift
This chapter describes in detail the surgical steps involved in the open coronal approach to brow lift. Anatomical landmarks, pitfalls, and planes of dissection at different levels and locations are discussed. Resection of frown muscles and fixation of sc
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Coronal Brow Lift Tuan Anh Tran and Seth R. Thaller
Indications
Possible Complications
1. Desire to minimize the frown lines and pro minent forehead creases to achieve a more youthful look 2. Reposition of brow ptosis, minimize forehead and glabellar rhytides 3. Reconstruction of significant facial paralysis involving brows and forehead
1. Scalp numbness 2. Permanent and long scar associated with alopecia 3. Elevation of anterior hairline 4. Alopecia
Essential Steps Preoperative Markings
T.A. Tran, M.D., M.B.A. (*) Division of Plastic Surgery, Department of General Surgery, University of Miami/Jackson Memorial Hospital, 1120 NW 14th Street, 4th floor, Miami, FL 33136, USA Division of Hand Surgery, Department of Orthopedic Surgery, University of California at Davis Medical Center, 4860 Y Street, Suite 3800, Sacramento, CA 95817, USA e-mail: [email protected] S.R. Thaller, M.D., D.M.D., F.A.C.S. Division of Plastic Surgery, Department of General Surgery, University of Miami/Jackson Memorial Hospital, 1120 NW 14th Street, 4th floor, Miami, FL 33136, USA e-mail: [email protected]
1. Mark the anterior hairline, transverse furrows, glabellar frown lines, supratarsal crease, and nasal root rhytides with the patient in the upright position. 2. Identify and mark supraorbital nerves, and supratrochlear nerves. 3. Mark the coronal incision 5 cm behind the receding line or at the hairline with a sawtooth incision.
Intraoperative Details 1. Place in supine position. 2. General anesthesia or Monitored Anesthesia Care. 3. Neurosurgical Mayfield horseshoe head rest maybe used to support the head.
© Springer International Publishing Switzerland 2017 T.A. Tran et al. (eds.), Operative Dictations in Plastic and Reconstructive Surgery, DOI 10.1007/978-3-319-40631-2_5
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4. Cleanse the hair, braid, and shave the hair to expose the proposed incisions. 5. Infiltrate the brow area with local anesthetic plus 1:100,000 Epinephrine. 6. Incise the skin and subcutaneous tissue down to pericranium. 7. Raise a subgaleal flap down to superior orbital rims. 8. Release galeal attachments along central and lateral orbital rims. 9. Release superolateral temporal fixation zone. 10. Identify and preserve supraorbital neurovas cular bundles. 11. Resect frontalis, corrugator, depressor super cilii, and procerus muscles. 12. Reposition the flap superolaterally and excise a strip of scalp. 13. Fixate the flap under no tension.
Postoperative Care 1 . Control blood pressure, and pain. 2. Patient is seen in 24 h to check the wound and change the dressing. 3. Patient can take down the dressing and shower at 48 h with a gentle shampoo and apply a wide hairband as directed by the doctor to cover the wound. 4. Remove permanent running sutures on POD# 7 in the office or staples at 10 days if used.
Operative Dictation Diagnosis: brow ptosis with severe forehead wrinkles Procedure: Coronal Brow Lift
Indication This was a ________ with significant forehead wrinkles with associated brow ptosis, who desired a more youthful and plea
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