Invited Discussion on: Subbrow Lift Using Frontalis Sling to Correct Lateral Orbital Laxity
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EDITOR’S INVITED COMMENTARY
Invited Discussion on: Subbrow Lift Using Frontalis Sling to Correct Lateral Orbital Laxity Mario Pelle-Ceravolo1
Received: 4 August 2020 / Accepted: 20 August 2020 Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. The anatomy of Oriental faces is in many ways different from that of the Caucasian race. This is particularly true in relation to the periocular region. Asians have higher eyebrows and wider upper eyelids than Caucasians [1]. They also have more pretarsal fat and suborbicularis fat, which create more volume inferiorly and tend to make their eyes puffy [2, 3]. Due to these peculiar features, several surgeons have developed different techniques with the aim of specifically addressing these issues. Parkes et al. [4] firstly, followed by other authors [5–7], proposed to place the incision in the subbrow area, remove an ellipse of skin and muscle and close the wound by direct skin approximation. This technique, despite offering interesting results, had the drawback of being prone to early recurrence, as the authors of the present paper report. Kim published a personal technique in which, after the excision of the excess tissue, the lower skin-muscle flap was anchored to the periosteum with the aim of obtaining more long-lasting results [8]. The authors of the present paper [9] should be congratulated for enrolling in this study and following for 6 months a considerable number of patients (437) in whom they carried out a subbrow lifting with a personal & Mario Pelle-Ceravolo [email protected] 1
Padua University, 35 Via Giovanni Severano, 00161 Rome, Italy
modification consisting in anchoring the OOM to the frontalis muscle. The authors assume that the most important innovation in their technique consists in the fact that through suturing the two muscles in a plane superficial to the galea and preserving so the periosteum intact would avoid any negative interference with the brow gliding plane. This technique, to their opinion, can avoid the downsides of Kim’s periosteal anchoring. This rationale sounds interesting on one side; there are, however, two issues to be considered: 1.
2.
In Dr Kim’s papers, there is no mention about limitations, problems or complications linked to the periosteal fixation. Respecting the integrity of the gliding plane is important in the supraorbital area where the frontalis muscle exerts its raising action on the brow. Kim’s periosteal fixation is carried out at the level of the upper orbital rim, i.e. more caudally to this gliding plane. This could explain why the authors of this procedure report no problems in the brow raising dynamics [8]. The authors believe that in Dr Kim’s technique ‘‘the frequent move
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