The outer half or tail of the brow bone can be reduced through an upper eyelid incision. This is useful in numerous clinical conditions where only the outer half of the brow bone needs to be changed such as in facial asymmetry (vertical brow bone elevation ) and in some types of facial feminization surgery. (horizontal and vertical reduction)
But when the tail of the brow bone is vertically lifted (vertical brow bone reduction) very often the tail of the eyebrow needs to go with it. But reducing the bone alone is no assurance that the eyebrow will follow the bone up with it. In fact, the eyebrow will not be lifted because the bone is changed because the periosteal attachments of the eyebrow to the bone have been released.
There are a variety of temporal browlift techniques that are available but the upper eyelid incision used for brow bone reduction provides a unique method for temporal browlifting. Through a temporal scalp incision that is placed back in the hairline in the direction of the desired lift of the brow, one end of a resorbable suture with the needle is passed through an elevated tunnel down to the exposed brow bone. The deeper tissues on the underside of the brow are grasped with the suture and the needle is passed back up into the temporal scalp incision. A bite of the deep temporals fascia is taken and the two ends of the suture tied down with the tension needed to create the amount of outer eyebrow elevation that is desired.
The transpalpebral brow bone reduction provides good access to do a concomitant temporal browlift to affect a complete reshaping of the outer half of the upper eye area.
Dr. Barry Eppley