Introduction
The term facelift broadly describes facial rejuvenation procedures encompassing various surgical techniques aimed at creating a more youthful and refreshed appearance. A key factor in defining a facelift is which portion of the face is treated, as this determines the specific surgical methods used. Traditionally, a facelift refers to treatment of the lower face—hence, it can be anatomically described as a neck-jowl lift. This procedure primarily improves the contour of the jawline and neck.
However, facelifts are often performed in combination with procedures that target the upper face, such as blepharoplasty or browlift, leading some to view the facelift as a full-face rejuvenation surgery. In reality, the facelift represents only one component of a comprehensive facial rejuvenation plan.
The facelift technique has evolved significantly—from simple skin-tightening procedures to deeper techniques involving the underlying muscular and connective structures. The most advanced version, known as the deep plane facelift, addresses not only the skin but also the superficial musculoaponeurotic system (SMAS) and the facial retaining ligaments. By releasing and repositioning these deeper structures, the surgeon achieves a more natural, longer-lasting elevation of the midface, jowls, and neck.
Importantly, the deep plane concept is not limited to the lower face. It can also be applied to the upper face, including the brow region, where it has been effectively used for many years in the form of a deep plane (or transcoronal) browlift.
Case Presentation
This patient previously underwent a coronal browlift that resulted in visible scarring along the entire incision line. She desired further brow elevation along with improvement of the scar’s appearance. Although she had a long forehead, this was not a concern for her. Additionally, she sought correction of sagging in the neck, jowls, and cheeks, leading to a combined surgical plan of a secondary coronal browlift with a lower facelift.
Under general anesthesia, the existing coronal incision was reopened from ear to ear, and the forehead flap was elevated over the brow bones and atop the deep temporal fascia. Relaxing incisions were made in the galea to allow maximal flap mobilization.
The forehead flap was advanced superiorly over the scalp to assess the amount of redundant anterior tissue that could be safely excised. The resection area was marked using needle placement along the proposed excision line.
The marked scalp segment was excised, and the coronal browlift was completed with maximal elevation.
The inferior portion of the coronal incision was left open temporarily to facilitate tissue redraping and removal during the lower facelift, ensuring optimal lifting vectors and aesthetic balance between the upper and lower facial units.
Discussion
A transcoronal browlift (also known as an open or coronal browlift) is a classic technique designed to elevate and smooth the forehead, reduce glabellar frown lines, and reposition ptotic brows. The approach involves an incision across the scalp, typically behind the hairline, extending from ear to ear. This provides direct visualization and access to the forehead tissues and underlying musculature. Although highly effective, this technique has largely been supplanted by endoscopic methods that minimize scarring.
Advantages of the Transcoronal Browlift
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Provides excellent exposure of the entire forehead and brow complex.
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Allows precise control of brow position and symmetry.
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Effectively smooths deep forehead wrinkles and frown lines.
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Delivers longer-lasting results compared to endoscopic or limited-incision lifts.
Disadvantages
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Potential for visible scarring if the hairline recedes or the incision is placed suboptimally.
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Risk of scalp numbness or altered sensation due to sensory nerve division.
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Longer recovery period and more swelling relative to less invasive approaches.
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Not ideal for patients with high foreheads or limited scalp laxity (who may be better candidates for pretrichial or endoscopic techniques).
Ideal Candidates
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Patients with heavy brows, deep forehead lines, or significant brow ptosis.
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Individuals with a low to moderate hairline and sufficient scalp laxity.
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Those seeking maximum lift and forehead rejuvenation.
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Patients with an existing coronal scar seeking secondary correction and improvement.
In this case, the patient’s prior coronal scar made a repeat transcoronal browlift the only viable secondary option. When combined with a lower facelift, this approach allows for synergistic lifting of the cheeks, jowls, and neck—enhancing the overall rejuvenation outcome and creating harmonious facial balance.
Key Points
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The transcoronal browlift functions as a deep-plane or subperiosteal upper facial lift, utilizing both flap advancement and scalp excision.
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In a secondary procedure, scar tissue limits flap mobility; therefore, additional brow and galeal releases are necessary to maximize elevation.
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Combining a transcoronal browlift with a lower facelift offers optimal lifting vectors for the cheeks and jowls, achieving a cohesive facial rejuvenation result.
Barry Eppley, MD, DMD
World-Renowned Plastic Surgeon