The Quantitated Internal Suture Browpexy: Comparison of Two Brow-Lifting Techniques in Patients Undergoing Upper Blepharoplasty

Purpose: To describe and evaluate 1) the quantitated internal suture browpexy (ISB), which combines the advantages of a browpexy and "brassiere suture," 2) the endoscopic Endotine browplasty, and 3) to compare these two techniques in patients undergoing simultaneous upper blepharoplasty. Methods: Retrospective review of patients undergoing bilateral upper blepharoplasty alone, bilateral ISB with upper blepharoplasty, and bilateral Endotine (MicroAire, Charlottesville, VA, U.S.A.) browplasty with upper blepharoplasty by one surgeon was performed. ImageJ 1.47v software (Wayne Rasband, National Institutes of Health, Bethesda, MD, U.S.A.) and standardized photographs were used to measure pre- and postoperative brow position at three positions (central, medial, lateral). Statistical analysis was performed using Sigmaplot version 12.5 for Windows (Systat Software, Inc., San Jose, CA, U.S.A.). Results: Thirty-three patients undergoing ISB with blepharoplasty, 33 undergoing Endotine browplasty with blepharoplasty, and 30 patients undergoing blepharoplasty alone were included. The 3 groups were matched for age and gender. Patients undergoing upper blepharoplasty alone showed statistically significant brow descent at all three brow positions (mean: -1.7 mm [p <= 0.04]). The quantitated ISB prevented brow descent but provided minimal brow elevation (mean lateral elevation: right eye (OD) +1.3 mm [p = 0.03]; OS + 0.9 mm [p = 0.08]). Endotine browplasty with upper blepharoplasty provided significant brow elevation at all brow positions, particularly laterally (OD + 4.0 mm [p < 0.001]; OS + 3.5 mm [p < 0.001]). There were no complications. Conclusions: Upper blepharoplasty alone is associated with brow descent; performing ISB simultaneously effectively prevents this descent. Endotine browplasty with upper blepharoplasty achieves significant brow elevation. Quantitation of the browpexy allows reproducible placement of the suture thereby producing consistent and symmetrical results.