The best, and often only, option for upper facial rejuvenation is the browlift. Some may consider an upper blepharoplasty (eyelid) part of the upper face, and I would not disagree, but we will exclude that procedure for this discussion. The browlift rejuvenates by elevating the position of the brows (sometimes changing the shape of the brow arch) and reducing the amount of forehead wrinkling.
Browlifts can be done through four specific surgical techniques, largely differing in the incisional approach. Three of these four browlift types are based on using scalp incisions. One of these scalp browlift options is the pretrichial approach where the incision is made just at the edge of the frontal hairline.
The pretrichial browlift, a close cousin to the traditional coronal or scalp browlift (incision significantly behind the frontal hairline), offers one very specific advantage over all other forms of browlifting. Since the incision is at the hairline, any amount of upper forehead movement (brow elevation) will not move one’s frontal hairline back or make the forehead longer. This is a real significant issue for some potential browlift patients who already have a long forehead. It is the one single physical finding that can solely determine the type of browlift chosen.
The endoscopic browlift, while dramatically shortening the length of incisions used, produces brow elevation at the expense of a longer forehead. This is the same issue as in the coronal browlift which lifts the forehead with a trade-off of a strip of scalp hair being removed and moving the frontal hairline back.
The hairline browlift also allows forehead wrinkling to be reduced through muscle removal of the forehead and between the eyebrows. Because the distance between the incision and the various muscle regions is the shortest of all the upper approaches, I find that the muscle is a little easier to remove and a more thorough job of that can potentially be done. Any form of open browlift, however, removes muscles of facial expression.
Despite leaving a scar that may be the most visible, the healing of the hairline scar can be quite good. In my Indianapolis plastic surgery practice, I have even performed it in women who comb their hair back or to the sides without a postoperative  problem. In theory, the density and quality of hair and its orientation of growth in relation to the forehead should be very important to the most inconspicuous scar. However, I have done hairline browlifts in women who have fine thin red hair to dark, coarse and curly hair with equally good scars.
Dr. Barry Eppley
Indianapolis, Indiana