Browlifting today is most often done through a limited incision approach albeit endoscopic, hairline or even through the upper eyelid. Historically the browlift was done through a coronal scalp incision, an approach which creates its lifting effect by removing a strip of hair bearing scalp. When the soft tissues are lifted off of the forehead and brow bones, pulled back and the excessive tissue removed the brows are lifted by the distant tissue pull. But because of the resultant long scar and the posterior movement of the frontal hairline, even when it was a more common facial rejuvenation procedure, the coronal browlift was limited to females.
The male browlift would almost never use a coronal approach for the obvious reason of the scar. But in the rare case of an existing coronal scalp scar in the male who seeks a browlift it is an opportunistic surgery. The question is not whether it can be used but how effective will it be and will the resultant scar from the browlift be as good as the existing scalp scar?
The effectiveness of a coronal browlift normally would not be a question. But there is a reason the coronal scalp scar exists and in this case it was from a prior skull reduction. As a result the forehead flap will be scarred from being elevated previously…meaning it will probably not be as easy to mobilize or will lift the brows as effectively if it never had prior surgery. It also means that horizontal galeal releases will be needed to optimize how much lift can be created.
The second coronal scalp scar is probably unlikely to turn out as good as the first one due to different purposes of why it was created. The initial scalp scar was done for skull reduction which means it was used for access and its closure was under no tension due to less bone. Conversely in a secondary browlift this will be different as the incisional closure will be under tension due to tissue removal and the lift.
Now the unspoken as of yet advantage this patient had is that he wears a hair piece… so the scar was not a major issue and the surgery aesthetically less risky.
Dr. Barry Eppley
World-Renowned Plastic Surgeon