WO2003070088A1

WO2003070088A1 - Improved surgical technique for eye brow lifting

Info

Publication number: WO2003070088A1
Application number: PCT/EP2003/001795
Authority: WO
Inventors: Alexander Tschakaloff; Randolf Von Oepen
Original assignee: Degima Medizinprodukte Gmbh
Priority date: 2002-02-22
Filing date: 2003-02-21
Publication date: 2003-08-28
Also published as: AU2003215581A1

Abstract

An improved surgical technique is described for elevating eyebrows of a patient for cosmetic purposes. The method includes the lifting and dissection of the periosteum and the use of at least one suture anchor to fix the elevated tissue to the bone. Advantageous is that no endoscopes are necessary and that micro-incisions allow direct approach and fixation of the soft tissues of the eyebrows and forehead. The suture anchors are placed directly at the new eyebrow and forehead position therefore avoiding hairline incisions and soft tissue fixation remote from the eyebrows as performed in current techniques.

Description

IMPROVED SURGICAL TECHNIQUE FOR EYE BROW LIFTING

Background of the Invention

The elevation of the eyebrows and the forehead is a common procedure for rejuvenating the upper third of a patient's face. The current technique includes dissection of the periosteum and release at the supraorbital rim and repositioning and fixation in a more cephalic position.

For completing an eyebrow lift procedure in the past invasive surgery was applied using standard surgical tools at open surgical sites, typically performing an incision of the skin with dissection of the periosteum. These basic methods were limited in their application.

More recently, surgeons started to use endoscopic techniques to perform brow lift procedures as described in US 5,950,633. In this patent the inventors describe a procedure for cosmetic surgery using micro-anchors under endoscopic control. A plurality of incisions are performed proximate to the soft tissue to be moved, an endoscope is inserted in one of the incisions and the soft tissue is undermined while this procedure is viewed through the endoscope. One or more micro-anchors are inserted into preformed pilot holes in the patient's cranium, the soft tissue is moved to the desired superior position and the soft tissue is sutured into that position using the suture thread attached to the micro-anchor. The disadvantages of this method are the use of an endoscope and the need of sufficient incisions to introduce the endoscope subperiosteally. Because of the size of the incisions, they are placed posterior of the hairline in order to make them less susceptible. This makes the procedure more difficult and less reliable in patients with a high hairline and makes it not available for bald patients with ptotic brows. Usually, these procedures are done under costly general anaesthesia. The hereby-disclosed invention provides a procedure, which avoids these disadvantages by attaching the elevated tissue directly at the desired position. Furthermore, this operation can easily be performed under local anaesthesia with or without sedation. It does not need the use of endoscopic instruments and is easier and faster at lower costs.

The inventive surgical procedure for supporting soft tissue of a patient's scalp in a superior position using a suture anchor comprises the steps of:

- making at least one incision to the soft tissue to be moved;

- inserting a dissector and lifting the tissue to be moved;

- inserting an instrument, comprising a proximal and a distal end, wherein the proximal end is formed as a handle and the distal end comprises means for dissecting tissue in a first plain and means for dissecting tissue in a second plain at the same time.

- drilling at least one hole at the desired position through at least one incision;

- tapping the at least one performed hole;

- providing at least one suture anchor having a generally cylindrical body and means or affixing a suture thread

- inserting the at least one suture anchor into the at least one hole;

- moving the tissue to the new position;

- placing a suture through the skin and burying the knots;

- closing the skin.

Brief Description of the Drawings

FIG. 1 is a view of the upper portion of the patient's face indicating possible incisions of the skin. It is possible to access from approximately 4 mm incisions in the eyebrows, skin folds or anywhere in the front-orbital region.

FIG. 2 is a view of the upper portion of the patient's face showing a miniaturized periosteal elevator lifting the periosteum. FIG. 3 is a view of the upper portion of the patient's face showing an instrument acting as both a (periosteal) knife and a (periosteal) dissector.

FIG. 4 is a view of the upper portion of the patient's face showing the drilling of holes at the elevated and repositioned eyebrow using a drill protector.

FIG. 5 is a view of the upper portion of the patient's face showing the insertion of the suture anchor, which may be armed with any appropriate suture thread chosen by the surgeon.

FIG. 6 is a view of the upper portion of the patient's face showing the elevated eyebrows and the sutures of the small incisions.

FIG. 7 shows a top view (A) and a side view (B) of a periosteal dissector.

FIG. 8 shows a top view (A) and three possible side views (B, C, D) of an instrument combining both a knife (non-guarded or guarded) and a dissector.

FIG. 9 shows a top view (A) and two possible side views (B, C) of a drill protector.

Detailed Description of the Invention

The present invention concerns an improved, efficient procedure for supporting the soft tissue of a patient's face in a superior position using anchor devices. It may be extended for cosmetic procedures in the middle and lower third of the face.

The patient's face is cleaned with an antiseptic solution and the patient is administered local anaesthesia. As shown in FIG. 1 several (as many as needed) incisions are made each approximately 4 mm in length. These incisions could be placed at alternative locations than shown in FIG. 1 and could vary in size and length without departing from the scope of this invention.

A (periosteal) dissector is then used (as illustrated in FIG. 2) to undermine the periosteum and soft tissues in the area of the desired procedure. The dissector is illustrated in FIG. 7 in a side and top view and is used to separate the periosteum from the bone of the forehead. As shown in FIG. 3, an instrument acting as both a (periosteal) knife and a (periosteal) dissector is subsequently used to both elevate the periosteum and incise it under protection of neurovascular bundles along a line parallel to the eyebrows. This use is time efficient, since it allows the surgeon to perform two steps in one. By the help of this instrument he could dissect and lift the periosteum simultaneous during the procedure. This instrument is illustrated in FIG. 8 in a top (A) and three possible side views (B, C, D). It could be made from any biocompatible material, preferably stainless steel. The first and second plain for dissecting tissue could include any angle, preferably the two plains are basically vertical to each other as illustrated in FIG. 8. In most cases the first plain will be applied basically parallel to the bone but dependent on the application it might be useful to choose a different angle for dissecting.

The surgical instrument could have any dimensions regarding the size of the dissecting means described above dependent on the medical application. Preferred is an instrument, wherein the length from the distal end to the proximal end of the means for dissecting tissue in the first plain is 5 to 20 mm, even more preferred approximately 10 mm. The means for dissecting tissue in the first plain are preferably up to 10 mm, in particular approximately 4 mm, broad. On the other hand the means for dissecting tissue in the second plain are preferably up to 4 mm, in particular up to 1 mm, broad.

A limitation of the depth of the periosteal incision could be guaranteed by a cutting depth of less than 2 mm and the according instrument may carry a protective body such as depicted in Fig 8 C and D. The limitation of the depth reduces the risk of injuries of the supraorbital neurovascular structures. As illustrated in FIG. 4 the periosteum including the eyebrow is elevated and at least one hole is drilled into the skull with a common surgical drill at the desired place. The surrounding skin is protected with an appropriate instrument. This drill protector is shown in FIG. 9. After taping of the holes at the new position of the eyebrow using a tap protector and a depth-limiting tap suture anchors are inserted into these holes by drilling or other ways known in the prior art (see FIG. 5).

Suture anchors are small devices for fixing sutures to the bone and consist out of cylindrical bodies that could be drilled into the bone and means for holding a thread that could be used for subsequent suturing. Normally the thread for the suture is already fixed to the anchor at this time. In many cases doctors use threads that have prefixed needles to facilitate the suturing and in addition reduce the size of the needle punctures during suturing. To be able to remove the drill protector after the placement of the suture anchors (including thread and needles) it is necessary that the lateral part of the drill protector provides an opening as illustrated in FIG. 9 A. Suture anchors that are less than 5 mm in length and have a major diameter of less than 4 mm are preferred for this procedure due to their small size. Preferably, the suture anchors and/or the thread for the suture are composed of a biodegradable material so that they will degrade after some time. In addition it is preferred to use a thin thread for the suture, in particular a thread that is approximately 0,5 mm or less in diameter.

As illustrated in FIG. 5 the tissue of the eyebrow area is finally fixed by a suture. After the free end of the suture thread that is attached to said anchor will be stitched through the periosteum directly above the eyebrow carefully lifted, the symmetrical position of the eyebrows has to be checked carefully. Then the suture thread is knotted to the placed suture anchors to fix the new position of the eyebrows.

The periosteum is attached to the suture anchor and the skin is closed in an appropriate manner. After fixation of the periosteum the skin is closed with a suture, surgical glue or steristrips. The final result both eye brows is illustrated in FIG. 6.

It might be necessary to elevate the part of the forehead proximal to the eyebrow to prevent additional wrinkles due to the elevation of the eye brow (see FIG. 1 and FIG. 6). In some cases it might be necessary to perform the described procedure only with one eyebrow dependent on the patient history.

It will be understood that the above-described procedure is only one example that illustrates the principle of the invention. Various modifications can be made by those skilled in the art without departing from the scope of this invention.

Claims

Claims:

1. A surgical procedure for supporting soft tissue of a patient's scalp in a superior position using a suture anchor, comprising the steps of:

- making at least one incision to the soft tissue to be moved;

- inserting a dissector and lifting the tissue to be moved;

- inserting an instrument being both a knife and a dissector;

- tapping the at least one performed hole;

- inserting the at least one suture anchor into the at least one hole;

- moving the tissue to the new position;

- placing a suture through the skin and burying the knots;

- closing the skin.

2. The procedure of claim 1 , wherein the suture anchor is composed of a biodegradable material.

3. The procedure of claim 1 , wherein the thread for the suture is composed of a biodegradable material.

4. The procedure of claim 1 , wherein the thread for the suture is approximately 0.5 mm or less in diameter.

5. The procedure of claim 1 , wherein the procedure is performed to elevate at least one eyebrow.

6. The procedure of claim 1, wherein the suture anchors are less than 5 mm in length and have a major diameter of less than 4 mm.

7. A surgical instrument comprising a proximal and a distal end, wherein the proximal end is formed as a handle and the distal end comprises means for dissecting tissue in a first plain and means for dissecting tissue in a second plain at the same time.

The surgical instrument of claim 7, wherein the first plain and second plain are basically vertical to each other. he surgical instrument of claim 7 or 8, wherein the first plain is applied basically parallel to the bone.

The surgical instrument of claim 7, wherein the length from the distal end to the proximal end of the means for dissecting tissue in the first plain is 5 to 20 mm, in particular approximately 10 mm.

The surgical instrument of claim 7, wherein the means for dissecting tissue in the first plain are up to 10 mm, in particular approximately 4 mm, broad.

The surgical instrument of claim 7, wherein the means for dissecting tissue in the second plain are up to 4 mm, in particular up to 1 mm, broad.

The surgical instrument of claim 7, wherein the instrument is used for dissecting and lifting the periosteum during the procedure according to claims 1 to 6.

The surgical instrument of claim 7, wherein the instrument is made from stainless steel.

A surgical procedure for supporting soft tissue of a patient's scalp in a superior position using a suture anchor, comprising the steps of:

- making at least one incision to the soft tissue to be moved;

- inserting a dissector and lifting the tissue to be moved;

- tapping the at least one performed hole;

- inserting the at least one suture anchor into the at least one hole;

- moving the tissue to the new position;

- placing a suture through the skin and burying the knots;

- closing the skin.