Patients with receding or high hairlines have traditionally been considered unfavorable candidates for endoscopic brow lift as this can further lengthen the hairline. We analyzed outcomes in patients that underwent a novel endoscopic brow lift technique with placement of incisions and anchoring Endotine Forehead Devices (CoApt Systems Inc, Palo Alto, CA, USA) directly at the natural forehead crease lines, in an effort to minimize elevation of the hairline, whereas providing well-hidden scars. We retrospectively reviewed all patients who underwent this new Endotine and incision placement between 2016 and 2020. Preoperative and postoperative photographs of all patients were analyzed to determine the postoperative changes in brow elevation and forehead length proportion (defined as length from cranium to chin).The forehead length proportion was unchanged pre-and postoperatively, with no statistically significant differences noted (P ¼ 0.48). The average brow position elevation ranged from 2.78 mm in the medial location to 5.05 mm in the lateral location. All patients were happy with their appearance and had improved visual fields postoperatively. The forehead scars healed well and were well hidden in forehead rhytids at long term follow-up.This novel endoscopic brow lift technique provides an option to utilize a minimally invasive approach in patients with receding hairline. With this technique, visible scars were minimized, whereas still being able to achieve reasonable brow elevation. Thus, our approach enables long term maintenance of brow elevation with inconspicuous scars in the forehead.

Antenatal Care (FAC) model uses risk stratification and fewer clinic visits. FAC can reduce the cost of antenatal care without compromising the quality. This current analysis estimates the cost impact to the Bahamian healthcare system by introducing FAC for qualifying pregnant women. Methods: A budget impact model was based on a cost-minimization associated with introduction of FAC for qualifying pregnant women using a WHO risk stratification tool. Direct medical expenses for laboratory tests, diagnostic procedures and visit costs were included in Bahamian dollar and weighted by utilization rates obtained from the hospital data. Indirect cost estimate was based on the literature and only included loss of wages and transportation. All costs were adjusted to 2015 US dollar. Analysis was conducted from a societal perspective with three-year time horizon. One-way sensitivity analysis was performed. Results: Estimates on women qualifying for FAC were derived from a retrospective study conducted at the Princess Margaret Hospital (PMH). On average 65.5% pregnant women qualifies for FAC in the Bahamas requiring three less clinic visits compared to current Standard Antenatal Care (SAC) with no significant difference in neonatal outcomes. Estimated total base case costs for FAC vs. SAC were $800 vs. $1,280, respectively. If clinicians choose FAC for qualified pregnant women over SAC, cost savings of $480 per case, of which 70.6% was attributed to indirect cost can be realized. This can be further extrapolated to $2,829,936 in three years considering average number of FAC qualifying women delivering in PMH per year. Sensitivity analysis indicated that introduction of FAC still offers cost savings. ConClusions: Introduction of FAC using lesser number of quality visits could be a better option that offers significant cost savings towards antenatal care in the Bahamas.

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