Transblepharoplasty brow suspension with a biodegradable fixation device.

BACKGROUND: Brow droop, eyelid tissue excess, and hyperfunction of the muscles of forehead facial expression may contribute to the aging diathesis of the upper one-third of the face. Many approaches to the brow have been described, including coronal or pretricheal incisions, direct incision of the suprabrow or forehead, and endoscopic techniques. A less frequent technique, the transblepharoplasty browlift (TBBL), has a role in rejuvenating brow position, especially in patients in whom both the eyelids and brows need to be addressed. The Endotine forehead device has been reported to increase speed and ease in providing operative support to the brows, but little has been written about its function with the TBBL approach. OBJECTIVES: The authors describe their results with Endotine brow fixation for browlift through a TBBL approach. METHODS: Between November 2005 and January 2008, 20 patients presented to the senior author (PRL) for browlift and were treated with a TBBL approach and placement of the Endotine device in one of three sizes (3 mm, 3.5 mm, or 4 mm). The surgeon completed an operative questionnaire immediately postoperatively, as well as a satisfaction questionnaire at one and three months postoperatively. Nineteen of the 20 patients were followed up also completed satisfaction questionnaires at one and three postoperative months. The results were tabulated to assess the safety and efficacy of the Endotine device. RESULTS: A 3-mm Endotine browlift device was placed in most patients (13; 68%). The surgeon was satisfied with the performance of the Endotine device, its ease of insertion, and the fixation provided in all cases. The Endotine was always palpable under the skin but visible in only roughly half of patients. At one month, 5% of the fixations were judged by the surgeon to be fair in appearance; the remainder of cases were satisfactory or better. At three months, all fixations were judged as satisfactory or better. Patients reported being very satisfied with the results of the surgery initially (53%), and satisfaction improved with time (74%). After three months, 79% of patients would recommend the procedure to others, an increase from 63% after one month. CONCLUSIONS: The Endotine device provides an effective lift for the brows, allows for easy repositioning, and is much quicker to apply than the sutures placed in a traditional browlift

Secular Buddhism and Justice

The core idea of secular Buddhism is to grasp the spirit of early Buddhism and transpose it into the present. An application of this idea to the doctrine of rebirth leads to the following result: The doctrine of rebirth cannot be revised in a strict sense, but there are some striking similarities between the ancient and modern (biological) view on the topic. Since the stream of genetic and epigenetic information has the power to create consciousness and reflects experiences of past lives, it can be associated with the stream of consciousness (cittasantana) in the Mahayana model of rebirth. Parents not only determine the genetic constitution of their children, but they also transfer character traits by means of epigenetic heredity. If genetic inheritance is associated with karma, then genes become an element of synchronic and diachronic connectedness (pratitya-samutpada). Instead of an individual learning process across successive lives, there is a collective learning process across successive generations. Given the biological model of rebirth, the belief in cosmic justice turns into a quest for mundane justice. There is a thought experiment for constructing such a concept, which complies well with the secular Buddhist spirit. John Rawls assumes that the legislative deliberation is taking place “behind a veil of ignorance”, so that the participants of the deliberation do not know their future genetic constitution and their future position within the society. If the participants imagine that their future self is contingent and impermanent – in accordance with the Buddhist doctrine of anatta and anitya – then the resulting principles of justice will be impartial