Background: Like the rest of the face the brows and forehead tissues do fall or go south with age. Besides the horizontal forehead lines and vertical glabellar wrinkles, the lowering of the brows is the most noticeable feature of aging of the upper third of the face. Sagging of the brows, as defined by where they are compared to the underlying brow bones, becomes relevant when the brows hang over the brow bones. This causes a frowning or scowling appearance and pushes upper eyelid skin downward.
Browlift surgery is a well known cosmetic procedure to lift sagging brows and partially deanimate some of the hyperactive forehead muscles. There are several types of browlift techniques which fundamentally differ by incision location and size and whether forehead/scalp tissues are removed or repositioned. The corona browlift is the historic procedure and the endoscopic technique is the more modern technique.
An intermediary browlift technique between the coronal and the endoscopic methods is that of the pretrichial approach. This browlift techniquesdoes use a scalp incision but it is located right at the hairline. This allows excess forehead skin to be removed to do an excisional browlift but does increase the vertical length of the forehead or create a scar back in the hairline that may cause some hair loss. It also allows a shorter open access to modification of the frontalis and glabellar muscles.
Case Study: This 56 year old female wanted a forehead rejuvenation to lift her sagging brows and open up her upper eyelids. She wanted her brows back up over the brow bones and to reduce some of her forehead wrinkle lines.
Under general anesthesia, she has a pretrichial browlift using an irregular hairline incision. Some of the glabellar muscles were excised and strips of frontalis muscle were removed. A total vertical length of 12 mms of upper forehead skin was removed along the hairline tapering it into the temporal area.
When seen at ten years after the original procedure it could be appreciated that her brows were still up higher than they were just before the original browlift surgery. Her forehead wrinkles were not much worse and her hairline scar was nearly imperceptible.
No anti-aging facial surgery is a permanent procedure. Aging of the face continues unabated and it is just a question of time until the results of the surgery is overcome. While each patient is different, it is a general statement that many facelifting procedures will last about ten years. This patient’s browlift shows that she is just about back to where she started a decade ago.
1) Browlift surgery is not meant to have a permanent result and does degrade over time.
2) An excisonal technique, like a pretrichial browlift, should have fairly long-term results over other non-excisional techniques.
3) This is an example of a ten year pretrichial browlift result which still shows some persistence of improvement over her initial preoperative result.
Dr. Barry Eppley