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Dr. Barry Eppley

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Posts Tagged ‘temporal browlift’

Multi Point Fixation Temporal Browlift

Sunday, October 11th, 2015


One of the signs of periorbital aging, amongst many, is the descent of the outer aspect or tail of the eyebrow. This is almost always more of an aesthetic issue in women than it is in men. For some women this may be the only aspect of brow descent that is troubling.  Botox injections are a good treatment for it but that is not a long-term strategy. Browlift surgery produces a more definitive result with longer lasting effects.

Different types of browlifts can be done from endoscopic to full coronal variations. The endoscopic technique is the most commonly performed browlift today. But as a trade-off for its limited use of incisions, it is prone to result in undercorrection. Specific temporal browlifts exist which involve different planes of dissection and methods of tissue fixation.

In the September 2015 issue of the Archives of Plastic Surgery, a paper on browlifts appeared entitled ‘Lateral Brow Lift: A Multi-Point Suture Fixation Technique’. In this clinical study a total of 519 patients were treated with a lateral brow surgery that essentially was a ‘dual plane’ technique. A temporal hairline incision was made with dissection along the deep temporal fascia to the superolateral bony orbital rim. Elevation of fixation of the lateral brow/orbital muscle tissues done up to the lateral edge of teh incision. Additional suture fixation was also done between the intermediate and superficial temporoparietal fascia and the deep temporal fascia. The excess temporal hair-bearing skin created by this elevation was then excised. Good ateral brow elevation was obtained in most patients (94%) with a relatively small number of complications. Total brow relapse (1.5%), partial relapse (4%), weakness of the frontal branch of the facial nerve (1%), and temporal scar widening/alopecia. (2%)

Temporal Bowlift results front view Dr Barry EppleyTemporal Browllift results oblique view Dr Barry Eppley IndianapolisSagging of the lateral brow usually occurs much earlier than that of the inner half of the eyebrow. The merging of the frontalis and orbicularis muscle out laterally can create a droop which pulls the skin below it downward as well. Isolated temporal browlifts attack this area directly. The most common temporal browlift is a skin only method that lacks any deeper tissue support. Multilayer or composite temporal browlifts have been described with dissection on top of the deep temporalis fascia to the orbital rim.

The temporal browlift technique described by this paper also involves a deep temporal plane of dissection but incorporates a periosteal release along the orbital rim. This creates greater tissue mobilization. Such tissue mobility allows for a greater elevation and expansion in the lateral canthal area. The different points of fixation of the different temporalis fascial layers to each other as well as the galea is major advantage of this technique and creates longer-lasting results.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Case Study – Temporal Browlifts with Lateral Canthopexies

Sunday, March 8th, 2015


Background: There are different types of browlifts that are done to help rejuvenate an aging eye area. The historic coronal browlift is done to lift up the entire brow arch through a long scalp incision way behind the hairline. An endoscopic browlift is performed using an endoscope through several small incisions just behind the hairline. A pretrichial  browlift is performed through incision that parallels the edge of the frontal hairline. in front of the hairline. All have their unique purpose and indication for forehead rejuvenation.

Temporal Browlift Dr Barry Eppley IndianapolisOne unique type of browlift is the temporal browlift. It is performed through an incision in the temporal scalp region at about 45 degrees upward from the tail of the outer brow. It is a limited browlift that just addresses the outer one third position or tail of the eyebrow. It is a very effective procedure for those patients, who are always women, that need only a lift in the outer one third of the brow.  By lifting the brow tail, it gives the eye a more open appearance without creating a surprise look.

Temporal browlifts are smaller incision procedures that lift the outside portion of the eyebrows which serves decrease the hooding that occurs with aging on the outer aspect of the upper eyelid. It can also improve wrinkles at the corners of the eye (crow’s feet) as lifting the temporal brow will flatten the wrinkles as the skin and muscle are placed on stretch with the elevation. When combined with an upper blepharoplasty (eyelid tuck) it can really have a substantial anti-aging effect of the upper eyes.

Case Study: This 62 year-old female wanted to improve the look of her eyes which became more tired looking as she was getting older. She previously had upper and lower blepharoplasties several years previously but had subsequently developed hooding of the outer upper eyelids. (inadequate temporal resection??)

Temporal Browlift results front view Dr Barry Eppley IndianapolisUnder general anesthesia, bilateral incisions were made of approximately 15 mms parallel to and 2 cms behind the hairline in the temple region. These were done along a line about 45 degrees outward from the tail of the brow. The incision was carried down to the deep temporal fascia. Using specially designed instruments dissection as carried down to the tail of the brow where the brow ligaments were released from the brow bone. The tail of the brow was lifted and secured with sutures to the fascia and the excess sin removed and closed. In addition hrough a 7mm skin incision in the outer eyelid skin crease, lateral canthopexies were performed. The outer corners of the eye were sutured up higher on the outer aspect of the lateral orbital rims with small permanent sutures. The skin incisions were closed with very small resorbable sutures.

Temporal Browlift results oblique view Dr Barry Eppley IndianapolisTemporal Browlift results side view Dr Barry Eppley IndianapolisHer one year after surgery pictures show sustained elevation of the tail of the eyebrow and an upward positioning of the outer corner of her eye. Lateral canthopexies add a degree of improvement to temporal browlifts by concomitantly lifting the corner of the eye as well. This is a subtle but complementary effect to the aging outer periorbital area.

Case Highlights:

1) Browlifts in females often focus on creating a higher outer tail of the brow or lateral brow sweep.

2) A lateral canthopexy lifts up the outer corner of the eye to fix a drooping eye or to create an upward tilt to the eye.

3) The combination of a temporal browlift and lateral canthopexies can provide a rejuvenated periorbital look in a female. or even a  ore exotic look if done more aggressively.

Dr. Barry Eppley

Indianapolis, Indiana

The Lateral (Temporal) Browlift for the Aging Forehead

Sunday, August 23rd, 2009

One of the many features of facial aging is changes in the upper face or forehead. As the forehead undergoes aging, horizontal wrinkles appear and the eyebrows descend lower. A lower position of the brows is medically known as brow ptosis. Brow ptosis and excess upper eyelid skin, if severe enough, may even impede on one’s vision.

As everyone has differently shaped and arched forms to their brows, the brows may drop down unevenly. Sometimes it is the inner or medial aspect of the brow that is too low…or it may be the outside or lateral part of the brow that sits below the prominent brow bone. Or it may be that the entire brow has fallen. In most patients, however, the outer or lateral third of the brow ages first and often the most. Aesthetically, eyebrow shape is more significant than height and eyebrow shape is highly affected by the level of the lateral brow.

For brow ptosis, a forehead or browlift procedure creates a rejuvenating effect. There are different methods of browlifting which can be done either through long open scalp or hairline incision or endoscopically through a few small scalp incisions. Browlift surgery, however, usually lifts the medial brow quite successfully but is weakest at raising the lateral brow. This is because the scalp incision from an open browlift tails off over the lateral brow area so not as much tissue is removed. In the endoscopic browlift, only the central part of the lift is secured by fixing it to the bone. The part over the lateral brow is lifted and secured to the temporalis fascia which is not as secure as that of bone.

Because of less effectiveness in lifting the lateral brow and that some patients only need to rejuvenate that brow area, the lateral browlift was devised. The lateral brow lift, also known as a temporal browlift uses incisions which are made at the temples behind the hairline. Skin is removed in this area and internal sutures are used to support the lifted tissue so the scars do not become wide afterwards. This is a simple procedure that can be quite effective. There is usually no connecting incision between the two temporal lifts.

The lateral browlift  can also deal with folds and small wrinkles in the forehead and the corners of the eyes (crow’s feet).  There is also a mild effect of lifting in the cheek area but this is usually fairly minor and one shouldn’t expect too much of a change in this area. Too much lateral brow lifting can produce an exotic look to the outer arch of the brow or a cat look, which is usually not desired by most women.

The lateral browlift may be done alone or as part of other browlifting techniques. It can be part of either an endoscopic browlift or as a modification of a traditional open browlift procedure.

Dr. Barry Eppley
Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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