13 Minimally Invasive Su-Por–Suture Temporal Brow Suspension: The Lift and Fill Technique
Abstract
Temporal eyebrow ptosis is very common in the aging face. Understanding how to address the tissue descent and volume loss with Su-Por, high-density porous polyethylene, is described here. The procedure is minimally invasive and performed with small incisions, and the recovery time is rapid.
13.1 Introduction
Many procedures have been developed to lift and fill the eyebrow tail for functional benefit and aesthetic enhancement. The lift and fill technique, too, was designed to elevate and provide fullness to the lateral eyebrow. The technique is quick and minimally invasive, and addresses the effects of aging: retro-orbicularis oculi fat (ROOF) atrophy and gravitational descent of the lateral eyebrow. The technique’s novelty lies in its use of a thin profile Su-Por implant, which becomes biointegrated into the tissue.
Su-Por is a porous high-density polyethylene produced by Poriferous, LLC, and is described in the literature as safe and effective. 1 ID#b166a980_2 – 3 It is commonly used in surgeries that add more support for facial features. 4 Its pore size ranges between 100 and 250 µm, which is an optimal range for rapid fibrovascular ingrowth. 5 The pore size is sufficient to provoke an immune response, thus reducing the rate of infection and extrusion when compared to other porous implants. Incorporation of tissue into the Su-Por implant is rapid; soft tissue ingrowth has been shown at 1 week and bone ingrowth at 3 weeks after implantation. 1 , 6 In revision rhinoplasty, Romo et al found a complication rate of 2.6% after implantation of porous polyethylene into 187 patients. 7
The advantages of the lift and fill technique over other suture suspension techniques and barbed suture techniques lie in its broad tissue integration. Elevating and suspending the ROOF with a porous scaffold along with deep anchoring of the tissue in the thick deep temporalis fascia plane prevents cheese wiring of the tissue. Most often, the lift and fill technique is combined with upper blepharoplasty, but it can be done in isolation. The procedure can be done in the office under local anesthesia or in an operating room setting with monitored or general anesthesia.
13.2 Goals of Intervention/Indications
Elevate, stabilize, and add volume to the lateral eyebrow.
Improve functional visual field when the lateral brow is ptotic preoperatively.
Minimal incisions to the face, avoiding noticeable scars as seen in direct, midforehead, and coronal incisions.
Minimal hair loss from small brow incision placement in the pre- or posttrichial space.
13.2.1 Risks of the Procedure
Bleeding.
Infection.
Asymmetric eyebrow elevation.
Palpable implant.
Implant migration.
13.2.2 Benefits of the Procedure
Aesthetic enhancement of the upper face.
Lift of the lateral eyebrow tail.
Youthful fullness of the eyebrow tail.
13.2.3 Informed Consent
Include risks and benefits (as above).
Mention implantation of a foreign material.
Though this use is novel, porous polyethylene has been used extensively in orbital and facial reconstruction for over 35 years.
13.3 Contraindications
Active infection in the area of implant placement.
13.4 The Procedure
The procedure described is quick and easy to perform, and can be done in an outpatient surgery center or in an office-based setting.
13.4.1 Instruments Needed (Fig. 13.1)
Su-Por Airo brow implants (two):
Catalog number 4442: small, one per package.
Catalog number 4443: large, one per package.
Catalog number 4444: small, two per package.
Catalog number 4445: large, two per package.
Ruler.
Wright needle.
Knapp lacrimal rake (two; B + L E4538).
Tenzel-Cottle periosteal elevator (B + L E4595).
Hemostat.
Sutures.
A 4–0 Prolene, clear suture for fixation of implant.
A 6–0 Vicryl suture for wound closure.
A 6–0 Prolene suture for wound closure.
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