Endoscopic brow lift

The endoscopic browlift is the currently the most commonly performed procedure for rejuvenation of the brow. The ideal candidate is a female patient with a normal or low hairline, thin skin, and a flat forehead. The endoscopic browlift can be performed in either a subgaleal or subperiosteal plane. Releasing the periosteum of the arcus marginalis and the orbital ligament adequately mobilizes the brow and helps achieve a long term result. The method of fixation of the brow varies with polylactic resorbable screws or bone tunnels. Some surgeons have found achieved long term brow elevation without the need for fixation. The endoscopic forehead lift has the advantage of minimal incision length and less risk of paraesthesias.

Coronal Browlift/Tricophytic Browlift/ Pretrichial Browlift

In a coronal browlift, the surgeon makes an incision within the hair-bearing scalp. The procedure will lead to elevation of the hairline. The plane of dissection is in the subgaleal plane allowing access to the frontalis, corrugator, and procerus muscles. Coronal browlifting is contraindicated in patient’s with high hairlines or male pattern baldness. In addition, paraesthesias are common after this technique due to resection of the deep branch of the supraorbital nerve.

The tricophytic browlift makes an incision within the fine hair of the anterior hairline. A reverse bevel allows for hair growth through the incision. A pretrichial variant places the scar in front of the hairline. Both approaches are effective in patients with high hairlines.

Midforehead Brow Lift/Direct Browlift

A midforehead browlift is made with an incision in a horizontal furrow in the forehead. A direct brow lift is made by directly excising skin above a patient’s brow. Typical candidates for both procedures include bald male patients with prominent forehead wrinkles and patients with a highly asymmetric brow (facial paralysis patients). Forehead wrinkles and corruagtor hyperactivity are not addressed with this technique.