Repositioning of an aesthetically low eyebrow can be done by a variety of browlift procedures. Historically and most commonly, an approach from the scalp (coronal, hairline or endoscopic) is how many browlifts have and are done. This is the most logical approach because lifting up or pulling back seems the right direction for an eyebrow that is too low. A more recent and diametrically opposite approach to lifting the low brow is to push from below. This is known as the transpalpebral (through the upper eyelid) browlift technique that uses a device (endotine) to achieve its effect.
The origin of the transpalpebral browlift is based on three issues. First, browlifting in men poses a unique challenge because of the dubious nature of their hairlines. Scalp approaches in men are usually unacceptable because of visible scar concerns. Coming from below through an eyelid incision is the only acceptable option for most men. Secondly, there are some women who may feel that the standard browlift approach is more than they want or need. They may desire a little browlifting but feel a scalp approach is too aggressive. Lastly, the sheer proximity of the upper eyelid to the brow bone makes the addition of a browlift through an upper blepharoplasty very convenient with very little additional risk and no extra incision.
An interesting question is how similar are the results from these two very different approaches to browlifting. In the December 2012 issue of Plastic and Reconstructive Surgery, a paper entitled ‘Morphometric Long-Term Evaluation And Comparison Of Brow Position And Shape After Endoscopic Forehead Lift And Transpalpebral Browpexy’. Photographs of patients who had received either an endoscopic browlift or a transpalpebral browpexy were morphometrically evaluated for brow height and brow shape up to five years after surgery. Their results show a significant elevation of the brow done through the endoscopic approach is both higher and more sustained than the transpalpebral technique. The descent of the eyebrow after the transpalpebral browpexy is felt to be caused by a decrease of frontal hyperactivity after the simultaneously performed blepharoplasty.
It should be no surprise that an endoscopic browlift causes a greater change in the brow’s position and shape as it is a bigger and much more powerful procedure. By comparison, the transpalpebral technique is much more limited in subperiosteal elevation and forehead flap movement. In an endoscopic method the entire forehead is mobilized and moved in one large tissue flap. The transpalpebral approach only mobilizes the brow. This study merely confirms what is intuitively obvious that a bigger operation is more effective and sustained than a smaller one.
While the transpalpebral browlift is less effective than other browlift methods does not mean it has no periorbital rejuvenation value. Its very simplicity and more subtle effects makes it well suited for those who need just a little browlifting or want a less invasive method of doing it. This particularly applies to many male patients who desire a browlift result that does not look overdone with too much brow elevation change.
Dr. Barry Eppley
Indianapolis, Indiana