PMC3728517_01
A 74-year-old man with left facial nerve palsy associated with marked brow ptosis, dermatochalasis, and lower eyelid laxicity (a). Complete closure of the right upper eyelid. Scleral show due to lower eyelid laxicity (b).
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fig1
Upon ophthalmological examination, the left brow was found to be localized 14 mm below its normal position with severe ectropion and horizontal laxicity of the lower eyelid resulting in scleral show (Figure 1(a)). The upper eyelid could be closed normally (Figure 1(b)).
Interrupted line extends at the level of 1/3 height of normal brow to the ptotic brow. Continuous line demarcated the inferior edge of the contralateral brow (a). Copy. The brow shape is copied on a transparent paper (b). Paste. The brow copy is localized on the interrupted line. By pasting the paper, the brow shape is copied above the ptotic brow (c). Excise. Excision of the outlined area (d). Stitch. Direct and layered closure (e).
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fig2
Since a lifted brow has a tendency to sag down to a lower position, an overcorrection of 1/3 of the normal brow height is attempted (Figure 2(a)). To achieve and warrant good symmetry for the brow position and shape, transparent paper is localized on the ptotic brow, and the shape of the brow is copied onto the paper (Figure 2(b)). The beginning and end points of the ptotic and copied brow are joined by vertical lines to complete the margins of the excision area (Figure 2(c)). A brow-shaped excision was formed (Figure 2(d)). Since the patient had brow ptosis due to facial palsy, a periosteal fixation along with two-layered suturing was facilitated (Figure 2(e)).
Postoperative 4-week view after brow lift with copy-paste-excise technique along with lateral canthal sling.
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fig3
During the 1st month of the follow-up period, the patient was happy and the result was satisfactory (Figure 3).