Endoscopic eyebrow lift was performed on 51 patients presenting with eyebrow ptosis due to facial paralysis. The resulting anthropometric measurements of eyebrow position were analyzed statistically to evaluate the effectiveness of this method. When preoperative eyebrow differences between the paralyzed and nonparalyzed sides were measured, the average difference at midpoint was 4.4 mm, and at the highest point, 4.6 mm. When the same points were measured postoperatively, the average difference at midpoint was 2.4 mm, and at the highest point, 2.3 mm. The difference in eyebrow height between the paralyzed and nonparalyzed sides correlated positively with age, both preoperatively and postoperatively. However, differences between preoperative and postoperative eyebrow height (which reflects the effectiveness of endoscopic eyebrow lift) at the highest point did not correlate with age and at the midpoint displayed a slightly negative correlation with age. These results suggest that endoscopic eyebrow lift is effective among young patients whose eyebrow ptosis is minor and is relatively ineffective among elderly patients whose eyebrow ptosis is severe. The conventional method of juxta-brow excision is indicated for elderly patients, for whom the operative scar is almost inconspicuous.
In the treatment of established facial paralysis, no known therapy can regenerate the paralyzed facial nerve and reanimate atrophied facial muscles. Current therapies therefore consist of procedures to correct each symptom, including inability to smile, lagophthalmos, and ptotic eyebrows. 1 Although eyebrow ptosis is a serious symptom, little attention has been paid to the restoration of eyebrow position compared with that given to the free vascularized muscle transfer for smile reconstruction. 2,3 A ptotic eyebrow results in a contracted palpebral fissure, leading to a decreased visual field. Lifting the ptotic eyebrow is therefore imperative, not only for improving cosmetic appearance, but also for restoring function.
Various surgical techniques have been reported for treating eyebrow ptosis. Adams used the frontalis muscle from the unaffected side for the dynamic reconstruction method. 4 However, because the frontalis muscle is thin and muscle strength is poor, the ptotic eyebrow cannot be well restored using this method. Eyebrow lift by direct excision of the skin above the ptotic eyebrow is often performed. 5 This method is simple and useful in balancing the height of both eyebrows. However, the scar above the eyebrow represents a definite disadvantage, particularly among young patients, although the scar is almost imperceptible among elderly patients. In addition, the arch shape of the eyebrow may be changed by skin resection, resulting in bilateral asymmetry of the eyebrows.
To overcome these problems, we applied an endoscopic subperiosteal forehead lift technique to treat eyebrow ptosis caused by facial paralysis. 6 The current article introduces our technique and the statistical analysis of our results.