"Endoscopic-assisted, subperiosteal browlift bone fixation technique outcomes: a systematic review and meta-analysis"

The optimal central forehead fixation method after endoscopic-assisted, subperiosteal browlift is an ongoing clinical controversy. There are two general categories of central forehead bone fixation: permanent bone fixation (e.g., fixation implants, bone tunnels) and temporary bone fixation (e.g., removable, percutaneous titanium screws). A systematic review and meta-analysis was performed to compare complication and revision surgery incidence rates using permanent versus temporary fixation after subperiosteal browlift for upper third facial rejuvenation.

PubMed and Embase databases were queried for studies reporting on adult patients undergoing endoscopic-assisted, subperiosteal browlift for upper third facial rejuvenation. Papers reporting on patients undergoing alternative browlift approaches, revision surgery, or browlifts with concomitant facial plastic procedures were excluded.

The database search yielded 296 unique studies, of which 13 met inclusion criteria. Data on article characteristics, patient demographics, and the most common complications were extracted. A meta-analysis of complication incidence rates revealed the pooled complication rates across both fixation categories to be <3% with a few exceptions. Significant differences were observed for asymmetry, contour irregularity, cyst formation, unfavorable scar formation, and need for revision surgery for complication correction. The pooled incidence rates of asymmetry, contour irregularity, cyst formation, and need for corrective surgery were higher in the permanent fixation group; however, the clinical relevance of this finding is debatable.

Central forehead bone fixation after subperiosteal browlift is a safe procedure with low complication risk. No difference in the rate of revision surgery due to the loss of fixation was observed between permanent versus temporary bone fixation.