Randomised controlled trial of direct brow lift: conventional technique versus fixed-periosteum technique in brow ptosis
- 1Ophthalmology, Phramongkutklao Hospital, Bangkok, Thailand
- 2Ophthalmology, Somdech Phra Nangchao Sirikit Hospital, Chonburi, Thailand
- 3Ophthalmology, Phramongkutklao College of Medicine, Bangkok, Thailand
Abstract
Objectives: To determine whether periosteal fixation improves the durability of brow elevation compared with the conventional direct brow lift and to evaluate its impact on postoperative outcomes.
Methods: In this patient- and assessor-blinded pilot randomised controlled trial, 10 patients with bilateral brow ptosis were randomised 1:1 to conventional direct brow lift or a fixed-periosteum modification with three-point orbicularis-to-periosteum fixation. The primary outcome was change in brow height from 2 weeks to 12 months. Bilateral measurements were averaged within participants for the primary analysis; a mixed-effects model accounting for fellow-eye correlation was supportive. Secondary outcomes included scar quality, satisfaction, operative time and complications.
Results: At 12 months, mean patient-level brow descent was 5.60±2.07 mm with conventional direct brow lift and 3.50±1.27 mm with fixed-periosteum lift, a between-group difference of 2.10 mm (95% CI −0.50 to 4.70, p=0.097). The supportive mixed-effects model yielded the same estimated difference (2.10 mm; 95% CI −0.03 to 4.23, p=0.054). Secondary outcomes were similar between groups.
Conclusions: In this pilot randomised trial, fixed-periosteum direct brow lift showed an estimated 2.1 mm reduction in brow descent at 12 months compared with the conventional technique. The estimate was consistent after accounting for bilateral correlation, although CIs included the null. These preliminary findings warrant evaluation in adequately powered multicentre trials.
Trial registration number: TCTR20231002002.
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BibTeX
@article{wannasupaphol2026randomised,
title = {{Randomised controlled trial of direct brow lift: conventional technique versus fixed-periosteum technique in brow ptosis}},
author = {Saran Wannasupaphol and Sombat Thanaboonyawat and Raveewan Choontanom},
journal = {BMJ Open Ophthalmology},
year = {2026},
month = nov,
doi = {10.1136/bmjophth-2026-003021},
url = {https://doi.org/10.1136/bmjophth-2026-003021},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Randomised controlled trial of direct brow lift: conventional technique versus fixed-periosteum technique in brow ptosis
AU - Saran Wannasupaphol
AU - Sombat Thanaboonyawat
AU - Raveewan Choontanom
PY - 2026
DA - 2026/11/03
JO - BMJ Open Ophthalmology
DO - 10.1136/bmjophth-2026-003021
UR - https://doi.org/10.1136/bmjophth-2026-003021
AB - Objectives: To determine whether periosteal fixation improves the durability of brow elevation compared with the conventional direct brow lift and to evaluate its impact on postoperative outcomes. Methods: In this patient- and assessor-blinded pilot randomised controlled trial, 10 patients with bilateral brow ptosis were randomised 1:1 to conventional direct brow lift or a fixed-periosteum modification with three-point orbicularis-to-periosteum fixation. The primary outcome was change in brow height from 2 weeks to 12 months. Bilateral measurements were averaged within participants for the primary analysis; a mixed-effects model accounting for fellow-eye correlation was supportive. Secondary outcomes included scar quality, satisfaction, operative time and complications. Results: At 12 months, mean patient-level brow descent was 5.60±2.07 mm with conventional direct brow lift and 3.50±1.27 mm with fixed-periosteum lift, a between-group difference of 2.10 mm (95% CI −0.50 to 4.70, p=0.097). The supportive mixed-effects model yielded the same estimated difference (2.10 mm; 95% CI −0.03 to 4.23, p=0.054). Secondary outcomes were similar between groups. Conclusions: In this pilot randomised trial, fixed-periosteum direct brow lift showed an estimated 2.1 mm reduction in brow descent at 12 months compared with the conventional technique. The estimate was consistent after accounting for bilateral correlation, although CIs included the null. These preliminary findings warrant evaluation in adequately powered multicentre trials. Trial registration number: TCTR20231002002.
SN - 2397-3269
ER -