eMedicine Specialties > Plastic Surgery > Brow Lift

Brow Lift, Periorbital Rejuvenation: Follow-up

Author: Gregory Caputy, MD, PhD, Chief, Department of Plastic Surgery, Aesthetica Plastic and Laser Surgery Center of Honolulu
Contributor Information and Disclosures

Updated: Jun 18, 2009

Outcome and Prognosis

The outcome for almost all patients is excellent and long-lived. The incision rarely is a concern, and hairdressers and beauticians often comment that it is excellent. The procedure rarely needs to be repeated, even after 20 or more years, because elevation is performed during the procedure and loose areolar tissue is removed, stopping descent of the brow with gravity and aging. The smoothness of the central brow region is difficult to achieve with any other procedure.

Preoperative photograph of patient prior to a bro...

Preoperative photograph of patient prior to a brow lift performed through the coronal approach.

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Preoperative photograph of patient prior to a bro...

Preoperative photograph of patient prior to a brow lift performed through the coronal approach.



Postoperative photograph demonstrating marked imp...

Postoperative photograph demonstrating marked improvement in the periorbital area after a brow lift performed through the coronal approach.

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Postoperative photograph demonstrating marked imp...

Postoperative photograph demonstrating marked improvement in the periorbital area after a brow lift performed through the coronal approach.



Preoperative photograph demonstrating a young fem...

Preoperative photograph demonstrating a young female patient with marked frown lines and congested appearance of the interbrow area with marked brow ptosis.

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Preoperative photograph demonstrating a young fem...

Preoperative photograph demonstrating a young female patient with marked frown lines and congested appearance of the interbrow area with marked brow ptosis.



Postoperative photograph demonstrating a young fe...

Postoperative photograph demonstrating a young female patient who had marked frown lines and congested appearance of the interbrow area with marked brow ptosis, after only a brow lift with corrugator supercilii muscle resection performed through a posterior coronal approach.

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Postoperative photograph demonstrating a young fe...

Postoperative photograph demonstrating a young female patient who had marked frown lines and congested appearance of the interbrow area with marked brow ptosis, after only a brow lift with corrugator supercilii muscle resection performed through a posterior coronal approach.



Preoperative view of a patient with brow ptosis, ...

Preoperative view of a patient with brow ptosis, marked actinic skin damage, and thin upper lip.

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Preoperative view of a patient with brow ptosis, ...

Preoperative view of a patient with brow ptosis, marked actinic skin damage, and thin upper lip.



Patient who had brow ptosis, marked actinic skin ...

Patient who had brow ptosis, marked actinic skin damage, and thin upper lip. Postoperative (1 wk) view after brow lift with corrugator muscle resection, full-face carbon dioxide laser resurfacing, and upper lip augmentation using autologous tissue.

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Patient who had brow ptosis, marked actinic skin ...

Patient who had brow ptosis, marked actinic skin damage, and thin upper lip. Postoperative (1 wk) view after brow lift with corrugator muscle resection, full-face carbon dioxide laser resurfacing, and upper lip augmentation using autologous tissue.

Future and Controversies

Currently, the largest controversy is the move to the endoscopic approach for the lift procedure.3 As mentioned previously, unless fixation is improved, the necessity of repeating the procedure and the inability to completely remove the corrugator supercilii muscle do not outweigh the problems with paraesthesia and anesthesia of the area and the scar. In all but a select few patients with severe baldness, the endoscopic approach offers little advantage to the open approach.

In the future, with better fixation, means to remove the loose areolar layer, and means of efficient visualization and cautery of the area of the corrugator muscle, the endoscopic approach may become the procedure of choice. A report of the use of an endoscopic handpiece on the carbon dioxide laser for help with bloodless corrugator removal has been presented, but concern exists regarding the supratrochlear nerve, which is likely damaged by this application of laser energy.4

Laser procedures for nonresurfacing tightening of the skin also may help with correcting skin laxity in the periorbital region. More recently, both monopolar and bipolar radiofrequency tightening of the thin skin of this area has shown promise, particularly in the "crow's feet" area. The longevity, safety, and efficacy of these procedures are not yet definitively supported by peer-reviewed literature.

Injectable agents for nasojugal groove correction are not without complication. The use of agents that completely resorb with time is preferable to the unevenness that may occur with long-term or permanent implants. Fat grafting in the area is fraught with problems of uneven contour. If a lower eyelid bag is present, the transposition, redraping, or repositioning of fat into the nasojugal groove while still attached to a stalk supplying blood to the tissue can be an excellent means of rejuvenation of this area.

 


More on Brow Lift, Periorbital Rejuvenation

Overview: Brow Lift, Periorbital Rejuvenation
Workup: Brow Lift, Periorbital Rejuvenation
Treatment: Brow Lift, Periorbital Rejuvenation
Follow-up: Brow Lift, Periorbital Rejuvenation
Multimedia: Brow Lift, Periorbital Rejuvenation
References
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References

  1. Flowers RS. Canthopexy as a routine blepharoplasty component. Clin Plast Surg. Apr 1993;20(2):351-65. [Medline].

  2. Rees TD, Jelks GW. Blepharoplasty and the dry eye syndrome: guidelines for surgery?. Plast Reconstr Surg. Aug 1981;68(2):249-52. [Medline].

  3. Dayan SH, Perkins SW, Vartanian AJ, Wiesman IM. The forehead lift: endoscopic versus coronal approaches. Aesthetic Plast Surg. Jan-Feb 2001;25(1):35-9. [Medline].

  4. Choo PH, Carter SR, Seiff SR. Carbon dioxide laser-assisted endoscopic forehead lift. Plast Reconstr Surg. Jan 1999;103(1):294-8. [Medline].

  5. De Cordier BC, de la Torre JI, Al-Hakeem MS, et al. Endoscopic forehead lift: review of technique, cases, and complications. Plast Reconstr Surg. Nov 2002;110(6):1558-68; discussion 1569-70. [Medline].

  6. Flowers RS. The art of eyelid and orbital aesthetics: multiracial surgical considerations. Clin Plast Surg. Oct 1987;14(4):703-21. [Medline].

  7. Flowers RS, Caputy GG, Flowers SS. The biomechanics of brow and frontalis function and its effect on blepharoplasty. Clin Plast Surg. Apr 1993;20(2):255-68. [Medline].

  8. Paul MD. The evolution of the brow lift in aesthetic plastic surgery. Plast Reconstr Surg. Oct 2001;108(5):1409-24. [Medline].

  9. Siegel R. Surgical anatomy of the upper eyelid fascia. Ann Plast Surg. Oct 1984;13(4):263-73. [Medline].

  10. Tower RN, Dailey RA. Endoscopic pretrichial brow lift: surgical indications, technique and outcomes. Ophthal Plast Reconstr Surg. Jul 2004;20(4):268-73. [Medline].

  11. Ziya S. Complications of long-lasting facial fillers. American Journal of Cosmetic Surgery. 2006;23:127-32.

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Further Reading

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Keywords

brow lift, periorbital rejuvenation, coronal lift, correction of tired-looking eyes, correction of crow's feet, browlift, brow-lift

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Contributor Information and Disclosures

Author

Gregory Caputy, MD, PhD, Chief, Department of Plastic Surgery, Aesthetica Plastic and Laser Surgery Center of Honolulu
Gregory Caputy, MD, PhD is a member of the following medical societies: American Medical Association, American Society for Laser Medicine and Surgery, Canadian Medical Association, Hawaii Medical Association, International College of Surgeons, International College of Surgeons US Section, Pan-Pacific Surgical Association, and Wound Healing Society
Disclosure: Nothing to disclose.

Medical Editor

R C A Weatherley-White, MD, Associate Clinical Professor of Surgery (Plastic), University of Colorado; Medical Director, Department of Plastic Surgery, Columbia Rose Medical Center
R C A Weatherley-White, MD is a member of the following medical societies: American Association of Plastic Surgeons, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Society for Aesthetic Plastic Surgery, Colorado Medical Society, and Royal Society of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Lars M Vistnes, MD, FRCSC, FACS, Professor of Surgery, Emeritus, Stanford University Medical Center
Lars M Vistnes, MD, FRCSC, FACS is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

 
 
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