Open Brow Lift Surgery for Facial Rejuvenation

Key points

  • Brow lifting is a gratifying operation; creation of a youthful eye/brow complex can by quite dramatic.

  • Repositioning of the brows can aid in the appearance of other structures of the upper face, such as the forehead rhytids, glabellar muscles, crow’s feet, and upper eye lids.

  • Although there are several acceptable methods of brow elevation, a pretrichial brow lift is a predictable, stable, and simple operation to satisfy the cosmetic needs of patients.

Introduction

Brow lifting has been around in the surgical armamentarium for nearly 100 years. Passot in 1919 first described using transverse skin excision of upper forehead skin to elevate the brows. In 1926, Hunt described coronal and hairline excision to achieve a similar result. In the following years, undermining of the pericranium and resection of corrugator muscles became popular. In the 1960s, other modifications such as the prertrichial incision were introduced. In the 1970s, the first description of a “biplanar” approach to the temporal region was described. Flowers has been given credit for emphasizing the importance of establishment of proper brow positioning before upper eye lid surgery. In 1992, Isse introduced the concept of minimally invasive forehead lifting via the endoscopic approach. Since then, there have been a number of modifications to both the “open” and “endoscopic” approaches for brow lifting.

This article describes the pretrichial brow lifting. Other types of forehead rejuvenation are described in another article (see Jon D. Perenack’s article, “ The Endoscopic Brow Lift ,” in this issue).

Indication for brow lift

Brow lifting is essentially synonymous with forehead lifting ; the terms are used interchangeably throughout this article. Irrespective of the type of forehead lifting, the main indication for any type of forehead lifting is to create a more youthful position for brows. Repositioning of the brows to a more appropriate position can also aid in the appearance of other structures of the upper face such as softening of the forehead rhytids, relaxation of glabellar muscles (corrugator, procerous, and depressor supercilia), improvement in appearance of crow’s feet, and enhancing the appearance of upper eye lids (by improving dermatochalasia of upper lids). An open, bright, and youthful appearance of the eyes and brows, especially in a female, is often one of the first facial features noticed by most people. Patients who have upper eye lid dermatochalasia or fullness often have concomitant brow ptosis. In fact, placing the brows to their proper position in many cases resolves the upper lid fullness.

Advantages of pretrichial brow lift

Pretrichial brow lifting falls in the category of open brow lifting. Other popular open brow lifting techniques include the coronal brow lift as well as mid forehead and direct brow lifting. Endoscopic brow lifting is the other popular technique utilized by many and is discussed in another article (see Jon D. Perenack’s article, “ The Endoscopic Brow Lift ,” in this issue).

Ultimately, regardless of the specific approach of brow lifting, elevation of the forehead and rejuvenation of the brows are the only objectives. Clinicians often argue over “inherent” advantages of one cosmetic procedure over another based on anecdotal or “personal” preference and experience. Although one should never argue against experience and consistency of a particular technique, there are a few advantages of the pretrichial brow lifting over other methods. These include:

  • Can allow shortening of a long forehead if necessary.

  • Can bring anterior hair line more anteriorly if desired.

  • No need for special equipment (endoscopic tower and/or instruments).

  • No need for fixation devices (resorbable anchors, etc).

Introduction

Brow lifting has been around in the surgical armamentarium for nearly 100 years. Passot in 1919 first described using transverse skin excision of upper forehead skin to elevate the brows. In 1926, Hunt described coronal and hairline excision to achieve a similar result. In the following years, undermining of the pericranium and resection of corrugator muscles became popular. In the 1960s, other modifications such as the prertrichial incision were introduced. In the 1970s, the first description of a “biplanar” approach to the temporal region was described. Flowers has been given credit for emphasizing the importance of establishment of proper brow positioning before upper eye lid surgery. In 1992, Isse introduced the concept of minimally invasive forehead lifting via the endoscopic approach. Since then, there have been a number of modifications to both the “open” and “endoscopic” approaches for brow lifting.

This article describes the pretrichial brow lifting. Other types of forehead rejuvenation are described in another article (see Jon D. Perenack’s article, “ The Endoscopic Brow Lift ,” in this issue).

Indication for brow lift

Brow lifting is essentially synonymous with forehead lifting ; the terms are used interchangeably throughout this article. Irrespective of the type of forehead lifting, the main indication for any type of forehead lifting is to create a more youthful position for brows. Repositioning of the brows to a more appropriate position can also aid in the appearance of other structures of the upper face such as softening of the forehead rhytids, relaxation of glabellar muscles (corrugator, procerous, and depressor supercilia), improvement in appearance of crow’s feet, and enhancing the appearance of upper eye lids (by improving dermatochalasia of upper lids). An open, bright, and youthful appearance of the eyes and brows, especially in a female, is often one of the first facial features noticed by most people. Patients who have upper eye lid dermatochalasia or fullness often have concomitant brow ptosis. In fact, placing the brows to their proper position in many cases resolves the upper lid fullness.

Advantages of pretrichial brow lift

Pretrichial brow lifting falls in the category of open brow lifting. Other popular open brow lifting techniques include the coronal brow lift as well as mid forehead and direct brow lifting. Endoscopic brow lifting is the other popular technique utilized by many and is discussed in another article (see Jon D. Perenack’s article, “ The Endoscopic Brow Lift ,” in this issue).

Ultimately, regardless of the specific approach of brow lifting, elevation of the forehead and rejuvenation of the brows are the only objectives. Clinicians often argue over “inherent” advantages of one cosmetic procedure over another based on anecdotal or “personal” preference and experience. Although one should never argue against experience and consistency of a particular technique, there are a few advantages of the pretrichial brow lifting over other methods. These include:

  • Can allow shortening of a long forehead if necessary.

  • Can bring anterior hair line more anteriorly if desired.

  • No need for special equipment (endoscopic tower and/or instruments).

  • No need for fixation devices (resorbable anchors, etc).

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Jan 23, 2017 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Open Brow Lift Surgery for Facial Rejuvenation
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