Jones Barry M, Grover Rajiv
Department of Plastic Surgery, Wellington Hospital, London, United Kingdom.
Plast Reconstr Surg. 2004 Apr 1;113(4):1242-50; discussion 1251-2. doi: 10.1097/01.prs.0000110206.25586.78.
Since the introduction of endoscopic brow lifting in the mid-1990s, it has become widely accepted as a method for rejuvenation of the upper third of the face. Despite the multitude of brow fixation techniques, there are few long-term studies providing accurate analysis of outcome. The aims of this investigation were to evaluate the long-term objective results of endoscopic brow lifting and to establish whether the technique of fixation altered the longevity of aesthetic outcome. The outcome of endoscopic brow lifts carried out on 538 consecutive patients over a 6-year period was assessed. For each patient, midpupil-to-brow distance was measured preoperatively and at intervals postoperatively. Two different fixation methods were compared: fibrin glue (n = 189, group 1; 104 records available) and polydioxanone sutures tied through bone tunnels (n = 349, group 2; 220 records available). In 214 patients, an upper lid blepharoplasty was performed simultaneously (85 in group 1 and 129 in group 2). At 1 month postoperatively, each fixation technique had produced a significant change in mean pupil to brow height (5.93 mm in group 1 and 6.21 mm in group 2, with no significant difference between the two methods; p = 0.17). However, when measurements were compared more than 3 months postoperatively (mean, 9.4 months), there was a significant difference, with some relapse in the patients treated with fibrin glue (p < 0.01). However, in group 2 (tunnel fixation), measurements remained stable, with 6.21 mm at 1 month compared with 6.16 mm long term (no significant difference, p = 0.34). In contrast, in group 1 (fibrin glue), measurements showed significant reduction, with a 1-month result of 5.93 mm and a long-term outcome of 3.79 mm (p < 0.01). Upper lid blepharoplasty had no effect on the long-term outcome of either group (p > 0.3 in group 1, p > 0.4 in group 2). Complications were few in both groups. In group 1, there was one infection, two instances of significant alopecia (both temporary), and one reoperation for relapse. In group 2, four patients required minor surgical revision of a lateral port scar and three minor areas of temporal alopecia, which recovered in less than 3 months. One patient had a paresis of the frontal branch that had recovered after 4 months. The endoscopic brow lift is therefore a safe and effective technique for increasing mean pupil to brow height. Fixation with polydioxanone sutures tied through bone tunnels produces a significantly more stable result than fibrin glue, without greater risk. This lends weight to experimental evidence that periosteal fixation must be maintained for at least 6 weeks to be secure.
自20世纪90年代中期引入内镜下眉提升术以来，它已被广泛接受为一种用于面部上三分之一年轻化的方法。尽管有多种眉固定技术，但很少有长期研究能对结果进行准确分析。本研究的目的是评估内镜下眉提升术的长期客观结果，并确定固定技术是否会改变美学效果的持久性。对连续6年内在538例患者身上实施的内镜下眉提升术的结果进行了评估。对每位患者，在术前和术后定期测量瞳孔中点至眉的距离。比较了两种不同的固定方法：纤维蛋白胶（n = 189，第1组；可获得104份记录）和通过骨隧道打结的聚二氧六环酮缝线（n = 349，第2组；可获得220份记录）。214例患者同时进行了上睑成形术（第1组85例，第2组129例）。术后1个月，每种固定技术均使平均瞳孔至眉高度产生了显著变化（第1组为5.93 mm，第2组为6.21 mm，两种方法之间无显著差异；p = 0.17）。然而，当术后3个月以上（平均9.4个月）进行测量比较时，存在显著差异，使用纤维蛋白胶治疗的患者出现了一些复发（p < 0.01）。然而，在第2组（隧道固定）中，测量结果保持稳定，1个月时为6.21 mm，长期为6.16 mm（无显著差异，p = 0.34）。相比之下，在第1组（纤维蛋白胶）中，测量结果显示显著降低，1个月时为5.93 mm，长期结果为3.79 mm（p < 0.01）。上睑成形术对两组的长期结果均无影响（第1组p > 0.3，第2组p > 0.4）。两组并发症均较少。在第1组中，有1例感染、2例明显脱发（均为暂时性）和1例因复发进行的再次手术。在第2组中，4例患者需要对外侧切口瘢痕进行小手术修复，3例颞部小面积脱发，在不到3个月内恢复。1例患者出现额支麻痹，4个月后恢复。因此，内镜下眉提升术是一种安全有效的增加平均瞳孔至眉高度的技术。通过骨隧道打结的聚二氧六环酮缝线固定产生的结果比纤维蛋白胶显著更稳定，且风险不大。这支持了实验证据，即骨膜固定必须维持至少6周才能稳固。
