title: A Novel Supra-Brow Combined with Infra-Brow Lift Approach for Asian Women.
abstract: BACKGROUND
  Direct brow lift surgery remains popular among Asian women despite its disadvantages. The traditional direct brow lift by a supra-brow incision is not suitable for Asian women because of their unique facial features, such as higher eyebrows, wider upper eyelids, and more orbital fat. Therefore, we designed a novel brow lift technique via a supra-brow combined with an infra-brow approach for Asian women.
  
  
  METHODS
  An area of skin above and below the eyebrow was measured, demarcated, and surgically removed. The redundant orbicularis oculi muscle (OOM) was excised while keeping the frontalis muscle intact. The OOM in the inferior flap was elevated and sutured to the frontalis muscle. In cases of puffy eyelids, orbital fat was partially removed through an infra-brow incision. Finally, a series of modifications were performed to reduce post-operative scarring.
  
  
  RESULTS
  A total of 496 patients underwent this surgery from July 2009 to December 2013 and 432 patients were followed up for at least 6 months after surgery. Post-operative scars, in most patients (428/432), were inconspicuous. There were no facial nerve injuries documented and eight patients reported transient forehead numbness. The height of the palpebral fissure was increased but there was no marked increase observed of the distance between the upper eyelid edge and the eyebrow. In follow-up visits, 409 out of 432 patients (94.7 %) were satisfied with their surgical results.
  
  
  CONCLUSIONS
  This new brow lift technique via a supra-brow combined with an infra-brow approach provided a simple and safe surgical repair of lateral brow ptosis, upper eyelids hooding, and crows' feet in Asian women. The surgical outcomes were predictable and the scars were inconspicuous.
  
  
  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 www.springer.com/00266 .
authors.affiliation: Institute of Plastic Surgery, Xijing Hospital, FMMU, Changle West Road 127#, Xi'an, 710032, Shaanxi, China. shumaoguo@163.com.
authors.forename: Maoguo
authors.initials: M
authors.lastname: Shu
authors.affiliation: Institute of Plastic Surgery, Xijing Hospital, FMMU, Changle West Road 127#, Xi'an, 710032, Shaanxi, China.
authors.forename: Lin
authors.initials: L
authors.lastname: He
authors.affiliation: Institute of Plastic Surgery, Xijing Hospital, FMMU, Changle West Road 127#, Xi'an, 710032, Shaanxi, China.
authors.forename: Yingjun
authors.initials: Y
authors.lastname: Su
authors.affiliation: Institute of Plastic Surgery, Xijing Hospital, FMMU, Changle West Road 127#, Xi'an, 710032, Shaanxi, China.
authors.forename: Junli
authors.initials: J
authors.lastname: Shi
authors.affiliation: Institute of Plastic Surgery, Xijing Hospital, FMMU, Changle West Road 127#, Xi'an, 710032, Shaanxi, China.
authors.forename: Xi
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Institute of Plastic Surgery, Xijing Hospital, FMMU, Changle West Road 127#, Xi'an, 710032, Shaanxi, China.
authors.forename: Xiangyu
authors.initials: X
authors.lastname: Liu
authors.affiliation: Institute of Plastic Surgery, Xijing Hospital, FMMU, Changle West Road 127#, Xi'an, 710032, Shaanxi, China.
authors.forename: Xueyuan
authors.initials: X
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D019882:Blepharoplasty / Q000009:adverse effects / Q000379:methods*; D002681:China; D002921:Cicatrix / Q000517:prevention & control*; D015331:Cohort Studies; D004954:Esthetics; D005138:Eyebrows; D005260:Female; D006801:Humans; D008875:Middle Aged; D056888:Patient Positioning; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000009:adverse effects / Q000379:methods; D013536:Suture Techniques; D016896:Treatment Outcome
keywords: Blepharoplasty; Cicatrix; Eyebrows; Rhytidoplasty; Suture techniques