Background: Correction of brow ptosis is one of the most common rejuvenative procedures of the upper third of the face. There are a wide variety of techniques to do so most of which are based on a superior lifting concept. Limited incision endoscopic techniques dominate but also frontal hairline and now rarely performed coronal excisional methods can also be used. Most of such browlifts are performed in females with reasonable to good hairlines and densities.
Browlifting in men, however, poses a unique brow lifting challenge which is really magnified when no hair exists or the frontal hairline is significantly retruded. In such male patients the traditional hairline or retro hairline superior lifting methods can not be used due to the location of the scarring. The browlift technique must be modified to either a more direct superior approach or an inferior transpalpebral (upper eyelid) technique.
In men with mild brow ptosis that is more laterally based the transpalpebral endotine browlift technique has value as a scar-free method. But when the brow ptosis is centrally based (between the pupil or in the glabellar region) the only option is a mid-forehead excisional method. This is a well established technique that has its merits, usually in older patients, but really in any age male patient that has one or several well indented horizontal wrinkle lines. While effective the tradeoff, of course, is the scar line with the objective the in the long run it is just seen as a deep wrinkle line that approximates what already exists.
Case Study: This male was tired of being told he always looked angry/mad when he really was not. He did have a direct browlift performed by another surgeon which did not really improve his appearance and feminized his eyebrows. (gave them a bit of an arch shape) He now sought a browlift method that could effectively treat the central brow region which was the real source of his negative look.
The excisional pattern for the mid-forehead lift was marked using the one true horizontal wrinkle line that he had. The skin was excised and the deeper muscle layer and nerves preserved.
Centrally dissection was taken down to the bone and into the frontonasal junction for complete tissue release.
A mesh material was attached to the superior tissue central brow tissues superiorly and the inferior end tucked into the frontonasal junction. Its purpose was two-fold; augment the frontonasal junction and create tissue ingrowth to keep the brow tissues fixed at the bone level after the lift..
T
he lift was completed by elevating and closing it in multiple layers with resorbable sutures with a resultant horizontal line. Upper and lower bkepharoplasties were also done.
Highlights:
- In shaved head males brow lifting is relegated to more direct superior and inferior techniques.
- With glabellar or central brow ptosis the mid-forehead lift provides the only effective method albeit with the tradeoff of a horizontal wrinkle line scar.
- The
Dr. Barry Eppley
World-Renowned Plastic Surgeon