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While the brow bone projection can be reduced and the forehead reshaped, the appearance of the upper face may still not be fully feminized in some patients. The arch of the eyebrows has an important feminizing influence and a brow lift with any type of forehead surgery can have a substantial gender enhancing effect. Lifting the brows, particularly their tails, creates a distinct arch to the eyebrows which many females desire.

Browlifting with Brow Bone Reduction/Forehead Reshaping

Browlifting can be concurrently done with any brow bone reduction either through a coronal scalp or pretrichial incisional approach. But when done with brow bone reduction/forehead reshaping the most effective and controllable browlift technique is done with a pretrichial hairline incision. In this technique upper forehead skin can be removed to create the change in brow elevation directly below it. (inner two thirds of the brows) A tail of the brow elevation requires an incision either at the temporal hairline or behind it to create the necessary lifting effect. In lifting the tail of the brow it is important to recognize that this portion of the brow must be lifted either equal to or often greater than the position of the inner half of the eyebrow. Many women prefer the upward sweep of the tail of the brow which is not a classically taught approach to traditional browlift surgery.

One of the ‘problems’ with the use of the coronal incision and browlifting is that it works by removing a strip of scalp skin/hair to create its effect. While this is the original form of browlift surgery, and has been used for decades (although largely not infrequently today) the removal of a strip of scalp seems like a waste of good hair that may be in short supply for some patients.

Temporal Browlifts

Browlift surgery can be done as an independent procedure or secondarily after the bony work of the forehead/brow bones, either as a known preoperative decision or to complement the previous work. What approach to use depends on the desired brow reshaping effect desired. Most of the time in the transgender FFS patient the focus is on the tail of the brow area and getting that upward temporal sweep of the arch.

The best method to do so is the combined transpalpebral-temporal incisional technique. By coming from below through the upper eyelid complete undermining and maximal mobilization of the tail of the brow can be achieved. This also creates the opportunity to do any tail of the brow bone reduction by burring if desired. The through a small temporal incision behind the hairline the tail of the brow can be resuspended by sutures to the deep temporal fascia way behind the incision.

Some females desire an ‘extreme’ or Cat Eye type of change to the outer eye/brow area. Like all maximal procedures it requires a maximal effort. This requires a combination of a transpalpebral-temporal tail of the browlift, with or without brow bone reduction, with a lateral canthoplasty to effect a change in position of the corner of the eye as well.

Dr. Barry Eppley

Indianapolis, Indiana

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