Brow ptosis is one of the earliest signs of periorbital aging. To surgically correct the aging brow, several brow lift procedures have been documented with varying amounts of success. Direct brow lift is regaining its popularity as it is a simple direct surgery that allows the surgeon a precise positioning, elevation, and shaping of the brow. However, unaesthetic scarring is a potential handicap of this technique. To reduce scarring, many methods have been proposed from different design markings, beveling the incision, and tissue suspension. The versatility of direct brow lift lies in its design, execution, tissue management, and reduction of tension in the scar. In this article, we present a refined modification of the classic direct brow lift technique. The procedure is based on anatomical landmarks with a versatile and reproducible design, a 20° beveled incision, and periosteal suspension of the orbicularis muscle. In our experience, the use of this technique has enabled us to attain long-term stable aesthetic results.
Blepharoplasty is a widely performed, tried, and tested procedure for periorbital rejuvenation. Most patients seeking cosmetic surgery of the lower eyelid are mostly concerned with excess skin, fat bags underneath their eyes, and a tired-looking appearance. A variety of techniques and approaches have been described for aesthetic alteration of the lower lid complex. For skin-only transcutaneous lower blepharoplasty, 2 surgical techniques have been described: the only skin flap and the skin pinch. In our experience, many patients seek only skin corrective resection fearing changes in their eye shape and some others have only excess skin. In this article, we will outline our approach to skin-only lower blepharoplasty. The boomerang technique is based only on skin removal with a superolateral vector design and can be incorporated, if needed, with other adjunctive procedures. To our knowledge, no previous article has described a precise and calculated design for skin removal. This serves the purpose of producing an aesthetic reproducible result with additional advantages inherent to the design over other techniques.
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