title: Biplanar temple lift for lateral brow ptosis: comparison with uniplanar dissection technique.
abstract: BACKGROUND
  The amount of lift achievable in the temple region has been limited by traditional uniplanar dissection techniques. A biplanar temple-lifting technique (BTL), involving a biplanar dissection both deep and superficial to the superficial musculoaponeurotic system (SMAS) of the temporal region, is described. This study compares the amount of temporal lifting that can be achieved using a uniplanar dissection with that achieved using a biplanar dissection.
  
  
  METHODS
  Thirty-seven patients underwent bilateral temple lifting. Deep dissection was performed on the surface of the deep temporalis fascia. The skin flap was pulled in a superolateral direction and the skin overlap at the wound edge was measured. A SMAS flap was then dissected beneath the dermis from the anterior wound edge to the temporal hairline. The SMAS flap was suspended superolaterally and fixated to the deep temporalis fascia. The skin flap was again pulled in a superolateral direction and the amount of skin overlap was measured and compared.
  
  
  RESULTS
  The average potential temple skin that could be excised using the traditional dissection technique was 15.1 mm (range, 7-24 mm). The average temple skin that was excised using the biplanar dissection technique was 21.8 mm (range, 14-30 mm). The biplanar technique was shown to offer, on average, a 48% increase in lift relative to the skin-only approach. There were no cases of wound dehiscence, necrosis, or overcorrection.
  
  
  CONCLUSIONS
  Using the BTL technique to create a temporal SMAS flap, dissected free from overlying dermis as well as from deep temporal fascia, provides a more secure suspension of the temporal flap and significantly greater temple lift than a uniplanar dissection. The deep layering absorbs the tension of the lift, allowing for tensionless skin closure, thus decreasing the potential for scarring, hair loss, and necrosis. The increased mobility and higher suspension of the temporal flap allows for more skin excision and therefore a more pleasing lateral brow height.
authors.affiliation: The Morrow Institute, 69-780 Stellar Drive, Rancho Mirage, CA 92270, USA. drhmarshak@morrowinstitute.com
authors.forename: Harry
authors.initials: H
authors.lastname: Marshak
authors.forename: Ariella A
authors.initials: AA
authors.lastname: Morrow
authors.forename: David M
authors.initials: DM
authors.lastname: Morrow
mesh_terms: D000328:Adult; D001763:Blepharoptosis / Q000601:surgery*; D062109:Dermatologic Surgical Procedures; D005138:Eyebrows; D005260:Female; D005546:Forehead / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D013701:Temporal Bone