Background: Aging effects the periorbital region through changes in the eyelids as well as the brows. Descent of the brows is a common feature of it but has aesthetic gender differences. Because men have a naturally lower and non-arched brow, some degree of brow sagging is much better tolerated in men than women. Unlike women, a low brow in men is not as often interpreted as being a negative facial feature.
But as some men age the combination of excessive upper eyelid skin and a dropping brow create both aesthetic and functional issues. The upper eyelid develops pseudoptosis due to the weight of the skin and overhanging brows. This causes a partial or complete loss of the upper visual field. This also creates a very tired and often unhappy appearance. Combining browlift and upper blepharoplasty surgery is a great combination for the older male who suffers this type of periorbital aging effect.
While a blepharoplasty in a male is no different than in females, the browlift technique often is. The lack of an existing or sufficient frontal hairline and scalp hair makes the choice of many standard browlift methods unusable due to visible scar concerns. (e.g., coronal, endoscopic or pretrichial browlifts) Incisions in the mid-forehead through a horizontal wrinkle line can be used but the scars take a long time to mature in a highly visible area.
Case Study: This 58 year-old male wanted to improve his tired eye appearance. He also did not like the heavy look of his eyes and how he also looked like he was squinting. He was a good candidate for a combined eyelid and browlift periorbital rejuvenation surgery.
Under general anesthesia, the skin removal for upper blepharoplasties was initially performed. Dissection was then done through the orbicularis muscle to approach the tail of the brow bone. Sunperiosteal undermining exposed the entire outside half of the brow bones.
A drill placed a hole in the bone 15mm above the lower end of the brow bone.
An endotine brow lift device was inserted with the prongs of it oriented in an upward direction. This device permitted the soft tissue of the brow to be lifted up and engaged into the device on its underside. The upper blepharoplasty incisions were then closed. He also had lower blepharoplasties performed as well.
His results at three months after surgery showed good improvement of is eyelid appearance. The heavy look to his eyes was gone and he expressed that he could see better because there was more light. His field of vision opened up.
The resorbable endotine browlift device offers a transpalpebral approach to performing a browlift. Unlike every other browlift achieves its effect by llifting the brows up. Coming from below the transplpebrak approach creates its effect by a ‘push’ effect rather than a pull. This makes its effects limited to the tail of the eyebrow and of a modest nature. There is no risk of creating a browlift result that is too elevated or overdone. These characteristics makes its use mainly for the male browlift candidate. Fortunately men prefer a very subtle browlift effect anyway. They are at much greater danger of looking surprised or unnatural from a browlift procedure.
Highlights:
1) The male browlift is challenging because most superior approaches rely on adequate scalp hair coverage.
2) The transpalpebral browlift offers a scarless technique that relies on the placement of a resorbable brow bone device placed through an upper blepharoplasty incision.
3) The transpalpebral browlift provides some modest lifting of the tail of the brow which is most appropriate for men.
Dr. Barry Eppley
Indianapolis, Indiana