title: Subbrow blepharoplasty using supraorbital rim periosteal fixation.
abstract: BACKGROUND
  Subbrow blepharoplasty (SBB) addresses lateral hooding of the upper eyelid skin, a shortcoming of classical upper blepharoplasty. Therefore, SBB is widely used by plastic surgeons in Korea and Japan. The aim of this study is to improve postoperative results and to minimize a relapse of existing SBB by the use of a supraorbital rim periosteal suture fixation technique.
  
  
  METHODS
  An upper incision is made along the inferior margin of the eyebrow. A lower incision, which is determined according to necessary amount of skin excision, is made vertically, deep to the posterior fascia of the obicularis oculi muscle (OOM). Then, skin, OOM, and posterior fascia of the OOM are excised en bloc. An upper skin flap dissection is extended to the width of 1 cm. The posterior fascia of the OOM in the inferior flap is pulled up and three transverse 5-0 nylon sutures are placed to fix it to the periosteum and the sub-brow fat of the supraorbital rim temporally to the supraorbital nerve. A margin of upper flap level is usually a suitable position for fixation. Thirty-six patients underwent SBB using the supraorbital rim periosteal suture fixation technique from July 2007 to June 2012.
  
  
  RESULTS
  Thirty-six patients underwent SBB and were followed up for an average of 27 months. The follow-up period ranged from 8 months to 6 years. Their mean age at the time of surgery was 55 years. Thirty-four patients (94.4 %) were satisfied with the surgical results, however, two patients (5.6 %) complained about dimpling at the periosteal suture fixation point. Administration of two focal injections of triamcinolone acetonide resulted in relief and disappearance of the dimpling.
  
  
  CONCLUSIONS
  We report our experience with a subbrow blepharoplasty using suture fixation of the OOM in the inferior flap to the supraorbital rim periosteum at the margin of the upper flap after an elliptical excision of subbrow skin. Our method of SBB has the advantage of ensuring the continuance of surgical results and minimizing the risk of relapse by placement of suraorbital rim periosteal fixation sutures.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .
authors.affiliation: Department of Plastic Surgery, Inha University School of Medicine, 7-206 Sinheung-dong, Jung-gu, Incheon, 400-711, Korea. plasticaa@hanmail.net.
authors.forename: Yeon Soo
authors.initials: YS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D019882:Blepharoplasty / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit; D010521:Periosteum; D013524:Surgical Flaps; D013536:Suture Techniques