Tisseal Can Facilitate Concomitant Brow Lifts

ATLANTA — Dermatologic surgeons who shy away from brow lifts are losing about 80% of their blepharoplasty patients, as most blepharoplasty candidates also need a concomitant brow lift. But a fibrin glue technique could change all that, Steven Rotter, M.D., said at the joint annual meeting of the American Society for Dermatologic Surgery and the American College of Mohs Micrographic Surgery and Cutaneous Oncology.

Brow lifts typically should be done before or at the same time as blepharoplasty, but many dermatologic surgeons are uncomfortable with the bone tunnels and fasteners usually used for central fixation during a brow lift. The technique described by Dr. Rotter involves the use of Tisseal—a fibrin glue product—instead of the bony fixation.

The glue is applied following complete release of the periosteum, and the tissue is held in place with even pressure for 2–3 minutes. Because studies have shown that fixation is required for 6–12 weeks in patients undergoing a brow lift, botulinum toxin type A is used to treat all of the depressors and thereby serves as an effective fixator for the needed duration, said Dr. Rotter, a dermatologic surgeon in private practice in Vienna, Va.

The use of the Botox means that muscles don't need to be removed, and the use of the glue means that bone holes don't need to be created. "And any dermatologist can easily do this in an hour or an hour and a half," Dr. Rotter said.

ATLANTA — Dermatologic surgeons who shy away from brow lifts are losing about 80% of their blepharoplasty patients, as most blepharoplasty candidates also need a concomitant brow lift. But a fibrin glue technique could change all that, Steven Rotter, M.D., said at the joint annual meeting of the American Society for Dermatologic Surgery and the American College of Mohs Micrographic Surgery and Cutaneous Oncology.

Brow lifts typically should be done before or at the same time as blepharoplasty, but many dermatologic surgeons are uncomfortable with the bone tunnels and fasteners usually used for central fixation during a brow lift. The technique described by Dr. Rotter involves the use of Tisseal—a fibrin glue product—instead of the bony fixation.

The glue is applied following complete release of the periosteum, and the tissue is held in place with even pressure for 2–3 minutes. Because studies have shown that fixation is required for 6–12 weeks in patients undergoing a brow lift, botulinum toxin type A is used to treat all of the depressors and thereby serves as an effective fixator for the needed duration, said Dr. Rotter, a dermatologic surgeon in private practice in Vienna, Va.

The use of the Botox means that muscles don't need to be removed, and the use of the glue means that bone holes don't need to be created. "And any dermatologist can easily do this in an hour or an hour and a half," Dr. Rotter said.

ATLANTA — Dermatologic surgeons who shy away from brow lifts are losing about 80% of their blepharoplasty patients, as most blepharoplasty candidates also need a concomitant brow lift. But a fibrin glue technique could change all that, Steven Rotter, M.D., said at the joint annual meeting of the American Society for Dermatologic Surgery and the American College of Mohs Micrographic Surgery and Cutaneous Oncology.

Brow lifts typically should be done before or at the same time as blepharoplasty, but many dermatologic surgeons are uncomfortable with the bone tunnels and fasteners usually used for central fixation during a brow lift. The technique described by Dr. Rotter involves the use of Tisseal—a fibrin glue product—instead of the bony fixation.

The glue is applied following complete release of the periosteum, and the tissue is held in place with even pressure for 2–3 minutes. Because studies have shown that fixation is required for 6–12 weeks in patients undergoing a brow lift, botulinum toxin type A is used to treat all of the depressors and thereby serves as an effective fixator for the needed duration, said Dr. Rotter, a dermatologic surgeon in private practice in Vienna, Va.

The use of the Botox means that muscles don't need to be removed, and the use of the glue means that bone holes don't need to be created. "And any dermatologist can easily do this in an hour or an hour and a half," Dr. Rotter said.