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Dr. Barry Eppley

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Posts Tagged ‘lactosorb screws’

Technical Strategies – Endoscopic Browlift Fixation with LactoSorb Screws

Friday, January 1st, 2016


Endoscopic Browlift Supraorbital Nerve Dissection Dr Barry Eppley IndianapolisThe most common surgical treatment today for sagging brows is the endoscopic browlift. As opposed to browlifts that involve long incisions and remove forehead or scalp tissue to create the lifting effect, the endoscopic technique uses minimal incisions and removes no tissue. It achieves a browlifting effect through a deep subperiosteal brow tissue release and a superior forehead and scalp backward tissue shift.

This relocation of the entire soft tissue of the forehead up and back, known as an epicranial shift, must be initially held in place to create the brow lift. A wide variety of endoscopic browlift fixation methods have been described since this browlifting technique was introduced about twenty years ago. Fixations methods including metal pins, metal screws, transosseous bone tunnels and resorbable grids or platforms. Each of these devices and methods have their advantages and disadvantages and the fact that so many endobrow fixation methods exist indicates that there is no perfect way to do it.

LactoSorb Endoscopic Browlift Screw Dr Barry Eppley IndianapolisHaving used all of these endobrow fixation methods, there is one that I found to be my favorite over the twenty years of performing the procedure. The use of LactoSorb resorbable screws offers a simple and very reliable soft tissue fixation method. This is a low profile 2.0mm screw made out of PLLA-PGA material which is naturally resorbed after 6 months of placement. It is a special resorbable screw that has a hole placed though its head and a pushpin design rather than that of a threaded shaft.

LactoSorb Endoscopic Browlift Drilled Screwhole Dr Barry Eppley IndianapolisLactoSorb Endoscopic Browlift Screw Suture and Lift Dr Barry Eppley IndianapolisThis fixation method issued by initially placing an outer cortical bone hole at the back end of the endo scalp incision. A suture is initially passed through the screwhead and then the screw is pushed into the bone hole. A snug fit allows the introducer for the screw to be removed. With the screw in place holding the suture, the uplifted scalp and forehead tissues are grasped with a bite of the suture and tied down. The overlying scalp incision is then closed.

Between the temporal lines of the skull, LactoSorb Endobrow resorbable screws can be used for central brow fixation. They are slightly palpable for a few months but their profile eventually flattens as they resorb over time. The time needed for natural fixation by healing of the elevated periosteum back down to the bone is reported to be a but a few weeks. So the months of fixation provided by the resorbable screw is more than adequate.

Dr. Barry Eppley

Indianapolis, Indiana

Endoscopic Browlift Surgery with Lactosorb Screw Fixation

Sunday, February 8th, 2009

Sagging of the brows with age has historically been improved through browlift surgery. Traditionally browlift surgery was done through long incision back in the scalp and the lift of the brows and forehead obtained was gotten by removing scalp skin. Endoscopic browlift techniques have become very popular in the past decade as they can accomplish browlifting but without the need for long scalp scars.

Like laparoscopic abdominal surgery, endoscopic browlifts use a few small incisions in the scalp and rely on releasing the brow and forehead from the bone through the assistance of small cameras and instruments. The actual lifting of the brows is really accomplished by shifting the forehead and scalp backwards, rather than cutting out scalp as in open browlift surgery. An essential part of this ‘scalp shift’ is that it must be held up in place until the tissues heal back down to the bone. Some form of soft tissue suspension or fixation is needed to make endoscopic browlift surgery work.

While there are many touted methods of endoscopic browlift fixation, and they all appear to work reasonably well, I prefer to use a resorbable screw placed into the skull from the small scalp incisions. Onto these screws, the forehead tissue can be sutures up to the screws holding it in place after surgery. Studies have shown that the tissues must be held in place for at least two weeks and preferably up to one month after surgery. These resorbable screws hold their strength out to 6 to 8 weeks, well beyond what is needed to accomplish forehead healing.

I have used these resorbable endobrow screws (Lactosorb) for the past 12 years and find their use quick and secure. In the old days, I used to have to cut threads into the bone to place the screw, but this has been replaced by a push screw several years ago. Patients may feel the screw
heads for a few months after surgery if they push hard enough, but that feeling goes completely away between 4 and 6 months after surgery. While metal screws will work just as well, patients find comfort in knowing that no permanent devices are left behind on their skull.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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