A Minor Modification of Direct Browplasty Technique in a Patient with Brow Ptosis Secondary to Facial Paralysis: Copy-Paste-Excise and Stitch

Purpose. This report aimed to describe a minor modification of the traditional direct browplasty technique that aids in surgical planning for patients with brow ptosis secondary to facial paralysis without changing the shape of the brow. Case Report. A 74-year-old male patient with left facial paralysis secondary to chronic otitis media was referred with a complaint of low vision due to brow ptosis. We performed direct browplasty with a minor modification in order to aid a treatment customized to the patient. In this technique, a transparent film paper is used to copy the brow shape. A brow-shaped excision is facilitated just superior to the ptotic brow. Conclusion. The authors found that the copy-paste-excise and stitch technique was effective and successful for deciding the shape and the amount of excision that should be performed in patients with brow ptosis without resulting in asymmetrical, arched, and feminized brows. 1. Introduction The brow consists of skin, subcutaneous tissue, muscle, and cilia and has a characteristic shape that is gender dependent [1]. In both men and women, the brow begins at the superomedial orbital rim and runs vertically through the medial canthus and nasal ala [2–4]. Although the beginning portion is similar, there are distinct differences between the two sexes. The normal position of the brow is just above the superior orbital rim in females and at the superior orbital rim in males. The female brow is more arched with a less prominent fat pad than males. In females, the brow arches above the supraorbital rim, whereas in men it arches only minimally along the rim [5]. The direct browplasty is suitable for any degree of brow ptosis secondary to injury of the temporal branch of the seventh cranial nerve in males as well as for older females with thick brows. It is an easy technique to perform, provides good control over the amount of brow lift, and gives predictable results [6]. The direct browplasty involves bilateral elliptical incisions immediately above the brows [7]. Closure of the elliptical excision area alters the brow’s shape resulting in an arched brow with the maximum arch being at the center of the brow and feminized appearance [6–8]. Besides, arching may lead to a surprised look or “clown” appearance. With this report we aimed to prevent this over-lifted appearance and achieve symmetrically localized brows with a minor modification in traditional direct browplasty procedure in patients with brow ptosis. 2. Case Report A 74-year-old Turkish male patient was referred with a complaint of low vision due to brow