Background: Aging around the eyes is the earliest and most visible signs of facial aging. Periorbital aging affects both the upper and lower eyelids as well as the brows that sit above them. Unless the eyelids which develop excessive skin, the eyebrows age by ‘falling down’, changing their position on the brow bone and losing their arch shape. As the brows descend they close down the eye space making the eyes look smaller and more tired.
The most common form of periorbital rejuvenation is blepharoplasty surgery. Since every person has four eyelids, cleaning up loose eyelid skin and fat can make a dramatic difference in the appearance of the eyes. Provided blepharoplasties are not overdone, blepharoplasty creates a refreshened or rejuvenated look to the eyes. Lifting the brows above the eyelids may or may not be also beneficial at the time of blepharoplasties and requires a presurgical lift test to determine.
Browlift surgery can be done by a variety of superiorly based methods. One of these browlift methods is the pretrichial technique. Through an incision along the frontal hairline the brows can be directly lifted without increasing vertical forehead length. (and can be used to actually lower it if desired) Its disadvantage is the concern about visible scarring along the hairline.
Case Study: This 50 year-old female was undergoing a variety of facial rejuvenation procedures. While she had blepharoplasties done in the past, her periorbital aging issue could be discerned to be more in her brow position than that of her eyelids. Here brows were low on the brow bones with a flat arch shape. This contributed to an almost angry facial appearance.
Under general anesthesia, he had a pretrichial browlift done using an irregular zigzag hairline incision. After undermining down to the brow ridge and releasing the periosteal attachments, a 7mm strip of upper forehead tissue was removed centrally and 9mms out laterally. The upper edge of the forehead tissues were secured in an elevated position by suturing it to the bone through outer cortical interosseous holes.
The pretrichial browlift is an almost exclusively female periorbital rejuvenation procedure. The usually stable and more dense female hairline allows for good hairline scar results. The opening of the eyes from the browlift as this point in your age is far more important than what a blepharoplasty could create.
Highlights:
- Sagging of the brows is defined by the position of the eyebrows on the brow bones.
- In women brow ptosis is defined as eyebrows that have a flat arch shape and are positioned at or below the brow bones.
3) The pretrichial browlift is the most direct approach to elevating sagging brows.
Dr. Barry Eppley
Indianapolis, Indiana