Ramirez O M
Division of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, Md., USA.
Plast Reconstr Surg. 1995 Aug;96(2):323-33. doi: 10.1097/00006534-199508000-00010.
The standard subgaleal coronal incision used for brow lifting is limited to patients with low foreheads. The subcutaneous hairline brow lift used for patients with high foreheads has a high rate of vascular complications. However, the main advantage of the subcutaneous approach is preservation of sensation posterior to the incision line. The subperiosteal approach, on the other hand, allows a better periorbital remodeling. I have combined the subperiosteal and the subcutaneous approach to take advantage of and minimize the disadvantages of each individual approach. The advent of the endoscopic technique has allowed more accurate and controlled periorbital dissection and brow depressor muscle modification. The operation is indicated in every patient in whom the anterior hairline incision is indicated. It is a good method for decreasing the height of the forehead. The dissection is done initially in the subcutaneous plane, and about halfway on the forehead slit incisions through the galea-periosteal layer and through the temporoparietal fascia are made to continue the dissection in the deep plane. The periosteal dissection and release at the arcus marginalis is done under endoscopic control. Likewise, the brow depressor muscle modification is done under endoscopic magnification. Deep anchoring sutures fix the brow in the elevated position. Trimming and closure of the cutaneous layer are done with minimal tension. The biplanar subperiosteal-subcutaneous forehead lift has been used in 24 patients with very satisfactory results. Complications have been of a minor nature. Patients have maintained sensation posterior to the hairline incision. The height of the forehead has been decreased in every case. Frontalis muscle function has been preserved.
用于提眉的标准帽状腱膜下冠状切口仅适用于额头较低的患者。用于额头较高患者的皮下发际线提眉术血管并发症发生率较高。然而，皮下入路的主要优点是切口线后方的感觉得以保留。另一方面，骨膜下入路能实现更好的眶周重塑。我将骨膜下和皮下入路相结合，以利用并尽量减少每种入路的缺点。内镜技术的出现使得眶周解剖和皱眉肌改良更加精确和可控。该手术适用于所有适合做前发际线切口的患者。这是一种降低额头高度的好方法。最初在皮下平面进行解剖，在前额大约一半处切开帽状腱膜 - 骨膜层和颞顶筋膜，以继续在深层平面进行解剖。在眉弓边缘处的骨膜解剖和松解在内镜控制下进行。同样，皱眉肌改良也在内镜放大下完成。深部锚定缝线将眉毛固定在抬高位置。皮肤层的修剪和缝合在张力最小的情况下进行。双平面骨膜下 - 皮下前额提升术已应用于24例患者，效果非常满意。并发症轻微。患者在发际线切口后方仍保留感觉。每例患者的额头高度均已降低。额肌功能得以保留。
