Browlifting is often a frequent component of eyelid rejuvenation. The tired look around one’s upper eyelids may be magnified by a low and falling eyebrow position. The combination of a browlift can make an upper blepharoplasty result look eve better and, at the least, reduce the amount of upper eyelid skin that needs to be removed.
One important consideration in a browlift procedure is it’s impact on forehead length. Of the different types of browlift techniques that are available, most will lift the brows at the expense of lengthening the forehead. This is because any browlift method that uses an incision behind the frontal hairline, albeit a long transverse incision or even an endoscopic approach, pulls back the hairline. As the brows move up, the hairline moves back. By actual measurement and based on proximity to the point of pull, the hairline moves back further than the brow moves up. (this is because the brow is furtherest from the point of pull)
For the women with an already long forehead, the proper browlift technique is done at the hairline. Known as a pretrichial or hairline browlift, the brows are lifted and the excess skin removed right at the hairline. As a result, the frontal hairline does not change. This does result in a very fine line scar right along the frontal hairline but with good hair density and hairstyle, it is not noticeable.
But what of the patient who already has a long forehead and is in need of a browlift? Long foreheads can be shortened by forehead skin removal and bringing the scalp flap forward. But can this be done at the same time as a browlift? The answer is yes. One may wonder how two skin flaps, with diametric movements, can converge and be stable. The key is to secure both skin flaps to the frontal bone. To prevent undesireable scar widening and some degree of flap relapse, a secure anchoring point is needed. The bone fixation point is generally about 2 cms. in front of the existing hairline. Using either outer cortical bone holes or suture anchors, sutures are used to secure the deep layers of both scalp and forehead skin flaps to these points after skin removal and dual flap elevation. The scalp flap can usually be advanced 2 cms. (hence the bone fixation point). The forehead flap which lifts the brow does not usually need to be elevated more than 7 to 10 mms, lest one develop the ‘deer in the headlights’ look after surgery.
Browlifting can and should incorporate forehead reduction in the patient who already has a long forehead. Shortening a forehead adds a rejuvenating effect that nicely complements the correction of brow ptosis. When properly done, it does not increase the risk of unfavorable scarring and any other risks of the procedure.
Dr. Barry Eppley
Indianapolis, Indiana