Chapter 77 Endosocopic Browlift with Deep Temporal Fixation Only 241
position without any tension (Figures 77.3 and 77.4). Brow fixation is achieved by securing the superficial temporal fascia medially to the deep temporal fascia in a superolateral vector with two 2-0 PDS horizontal mattress sutures while the brow is lifted laterally and overcorrected. The overcorrected brow will gradually drop to its final position after 3 weeks. The incisions are closed with surgical staples.
Results (Before and After Photographs)
Since January 2000, the author has performed endoscopic browlifts with
DTFO in more than 150 patients with good results (Figures 77.5 through
Figure 77.7). This procedure has the advantage of addressing the ptotic eyebrow while avoiding bony fixation. The endoscopic browlift with DTFO may be combined with the endoscopic subperiosteal transtemporal transbuccal midface lift to rejuvenate the aging forehead, brow, and midface.
As with any new procedure, thorough knowledge of the current literature and anatomy and observation of this procedure by an experienced surgeon should prelude your attempt in performing the endoscopic browlift with DTFO.
Figure 77.1. Marking of the temporal incision (large arrow) parallel to the tail of the brow with its medial extent at the temporal conjoint fascia (small arrow).
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Figure 77.2. The temporal incision has been made and taken down to the deep temporal fascia.
A
Figure 77.3. Patient before (A) and 1 week after (B) endoscopic browlift with deep temporal xation only (DTFO). (C) Intraoperative photograph of the patient’s elevated brow complex to an unnaturally high position after a complete release of all periosteum and brow depressor musculature prior fixation.
Chapter 77 Endosocopic Browlift with Deep Temporal Fixation Only 243
B
C
Figure 77.3. Continued
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Figure 77.4. Intraoperative photograph of a patient’s elevated left brow complex after a unilateral complete release of all periosteum and brow depressor musculature prior to fixation. Q-tips positioned at the inferior border of the supraorbital rim.
A 
B 
Figure 77.5. Middle-aged patient with brow ptosis and fat herniation of the lower eyelids—before and 20 months postoperatively following DTFO endoscopic browlift and bilateral lower fat repositioning blepharoplasty. Notice the orbital region is rejuvenated with the natural shape of the eyebrow kept intact.
(A) Frontal of before (left) and after (right). (B) Left oblique of before (left) and after (right).
Chapter 77 Endosocopic Browlift with Deep Temporal Fixation Only 245
A
B
Figure 77.6. 43-year-old-male status post an upper blepharoplasty four years ago now complaining of a “tired look”: right oblique of before (left) and after (right). The brow, especially in the temporal region, descends below the supraorbital rim causing temporal hooding and the supratarsal crease is covered by overhanging ptotic upper eyelid skin. Following a DTFO endoscopic browlift, the patient’s brow ptosis is moderately improved.
246 P.S. Nassif
A 
B
Figure 77.7. 41-year-old-patient with brow ptosis and fat herniation of the lower eyelids. Following DTFO endoscopic browlift and bilateral lower transconjunctival blepharoplasty, notice the significant medial brow elevation. (A) Frontal of before (left) and after (right). (B) Left oblique of before (left) and after (right).