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Background: The appearance of the forehead is heavily dependent on the hair bearing areas that frame it. The frontal hairline is the superior border (at least for women) and the eyebrows are the inferior border. The location of the frontal hairline controls the vertical length of the forehead while the eyebrows influence  the appearance of the eyes s well as how long the forehead looks.

The surgical procedure of a frontal hairline advancement is well known for shortening the vertical length of the forehead. This procedure works by undermining the scalp and relying in its mobility to move the hairline forward. The amount of forehead skin removed is determined by first moving the hairline over the upper forehead skin, seeing how far it goes and then committing to the amount of forehead skin to be removed. In most cases such hairline advancements do not affect the eyebrow positions or inadvertently elevate the eyebrows since the forehead skin has not been undermined. But in very large hairline advancements it is very possible to see at least some temporary eyebrow lifting effect.

For deliberate browlifting the direct hairline approach is one very effective option. All browliftng options share one theme in common…the removal or transposition of forehead skin. In the direct browlift technique the forehead skin and eyebrow tissues are undermined/released and the brows lifted by a measured removal of forehead skin at the frontal hairline.

An interesting merger on these two forehead reshaping techniques occurs when the patient desires both a hairline advancement and a browlift at the same time.

Case Study: This female desired a reduction in the length of her forehead (currently 6.5cm vertical length) as well as a strong browlift at the same time.

Under general anesthesia and through a frontal hairline incision the entire scalp behind it was undermined at the subperiosteal level on the bone and off of the deep temporal fascia on the sides of the head. In front of the incision the forehead skin and brow tissues were undermined and released working around the supraorbital nerves. Both mobilized scalp and forehead flaps were advanced in opposite directions with the inferiorly moved frontal hairline scalp going over the superiorly forehead skin and stapled into position. The new position of the hairline was marked on the forehead skin which determined the amount of forehead skin removal to achieve both effects.

The forehead skin was removed and each flap secured to each other with deeper galeal sutures. The skin was then closed with multi-layer resorbable sutures. The vertical length of the forehead went from 6.5 to 4.5cms. 

Case Highlights:

1) A direct browlift uses a frontal hairline incision which has good control of the elevated eyebrow position due to measured forehead skin removal. 

2) A frontal hairline advancement relies on scalp mobilization and forehead skin removal.

3) Combining a frontal hairline advancement with a direct browlift is synergistic as both rely on forehead skin removal for their effects.

Dr. Barry Eppley

World Renowned Plastic Surgeon

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