eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Cosmetic Surgery

Browplasty: Multimedia

Author: J David Kriet, MD, FACS, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Director of Facial Plastic and Reconstructive Surgery, University of Kansas School of Medicine
Coauthor(s): Paulino E Goco, MD, Consulting Staff, Division of Facial Plastic and Reconstructive Surgery, Middle Tennessee Ear, Nose and Throat
Contributor Information and Disclosures

Updated: Nov 25, 2008

Multimedia

Woman demonstrating ideal brow aesthetics. Note t...
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Media file 1: Woman demonstrating ideal brow aesthetics. Note the gentle curving shape of the brows, which are positioned slightly above the orbital rims. The highest arching point should lie between the lateral limbus and lateral canthus. The tail of the brow lies on a line drawn between the lateral canthus and lateral nasal ala.
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Woman demonstrating ideal brow aesthetics. Note t...

Woman demonstrating ideal brow aesthetics. Note the gentle curving shape of the brows, which are positioned slightly above the orbital rims. The highest arching point should lie between the lateral limbus and lateral canthus. The tail of the brow lies on a line drawn between the lateral canthus and lateral nasal ala.

Cadaver dissection demonstrating supraorbital ner...
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Media file 2: Cadaver dissection demonstrating supraorbital nerves (arrowheads); periosteum has been incised.
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Cadaver dissection demonstrating supraorbital ner...

Cadaver dissection demonstrating supraorbital nerves (arrowheads); periosteum has been incised.

Cadaver dissection of corrugator musculature.
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Media file 3: Cadaver dissection of corrugator musculature.
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Cadaver dissection of corrugator musculature.

Cadaver dissection of corrugator musculature.

Cadaver specimen showing the temporoparietal fasc...
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Media file 4: Cadaver specimen showing the temporoparietal fascia (held by a skin hook) dissected from the deep temporalis fascia; the temporalis muscle fibers are visible through the deep temporal fascia.
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Cadaver specimen showing the temporoparietal fasc...

Cadaver specimen showing the temporoparietal fascia (held by a skin hook) dissected from the deep temporalis fascia; the temporalis muscle fibers are visible through the deep temporal fascia.

Preoperative photograph of 61-year-old man concer...
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Media file 5: Preoperative photograph of 61-year-old man concerned with visual-field limitation in superior and lateral gaze. Note marked brow ptosis and dermatochalasis with hooding. This patient is a candidate for functional browplasty and blepharoplasty.
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Preoperative photograph of 61-year-old man concer...

Preoperative photograph of 61-year-old man concerned with visual-field limitation in superior and lateral gaze. Note marked brow ptosis and dermatochalasis with hooding. This patient is a candidate for functional browplasty and blepharoplasty.

Visual-field test of the patient in Image 5. Note...
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Media file 6: Visual-field test of the patient in Image 5. Note the dramatic improvement in visual fields when the brows and upper eyelid skin are elevated and taped (blue line, relaxed; red line, taped; green area, visual-field improvement).
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Visual-field test of the patient in Image 5. Note...

Visual-field test of the patient in Image 5. Note the dramatic improvement in visual fields when the brows and upper eyelid skin are elevated and taped (blue line, relaxed; red line, taped; green area, visual-field improvement).

Patient from Image 5, two months following endosc...
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Media file 7: Patient from Image 5, two months following endoscopic browlift and upper and lower blepharoplasties. The patient's visual-field complaints resolved with surgery.
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Patient from Image 5, two months following endosc...

Patient from Image 5, two months following endoscopic browlift and upper and lower blepharoplasties. The patient's visual-field complaints resolved with surgery.

Preoperative photo of a 59-year-old woman prior t...
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Media file 8: Preoperative photo of a 59-year-old woman prior to an endoscopic browlift, lower lid transconjunctival blepharoplasty, rhytidectomy, and carbon dioxide laser resurfacing.
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Preoperative photo of a 59-year-old woman prior t...

Preoperative photo of a 59-year-old woman prior to an endoscopic browlift, lower lid transconjunctival blepharoplasty, rhytidectomy, and carbon dioxide laser resurfacing.

Patient from Image 8 seen 6 months postoperativel...
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Media file 9: Patient from Image 8 seen 6 months postoperatively.
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Patient from Image 8 seen 6 months postoperativel...

Patient from Image 8 seen 6 months postoperatively.

A: Brow and facial asymmetry resulting from left ...
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Media file 10: A: Brow and facial asymmetry resulting from left idiopathic facial nerve paralysis. B: Four-month postoperative view showing improved brow symmetry following trichophytic browplasty. Plication of the left facial superficial musculoaponeurotic system and placement of a facial sling were performed simultaneously.
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A: Brow and facial asymmetry resulting from left ...

A: Brow and facial asymmetry resulting from left idiopathic facial nerve paralysis. B: Four-month postoperative view showing improved brow symmetry following trichophytic browplasty. Plication of the left facial superficial musculoaponeurotic system and placement of a facial sling were performed simultaneously.

Reverse beveling of the trichophytic incision enc...
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Media file 11: Reverse beveling of the trichophytic incision encourages hair growth through the incision.
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Reverse beveling of the trichophytic incision enc...

Reverse beveling of the trichophytic incision encourages hair growth through the incision.

A: Trichophytic frontal incision. B: Subgaleal di...
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Media file 12: A: Trichophytic frontal incision. B: Subgaleal dissection of the flap is quick and relatively bloodless. Arrowheads denote supraorbital nerves that should be preserved.
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A: Trichophytic frontal incision. B: Subgaleal di...

A: Trichophytic frontal incision. B: Subgaleal dissection of the flap is quick and relatively bloodless. Arrowheads denote supraorbital nerves that should be preserved.

Early postoperative view of trichophytic incision...
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Media file 13: Early postoperative view of trichophytic incision. Reverse beveling of the incision at the time of surgery promotes hair growth through the incision.
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Early postoperative view of trichophytic incision...

Early postoperative view of trichophytic incision. Reverse beveling of the incision at the time of surgery promotes hair growth through the incision.

A 76-year-old man with left unilateral facial par...
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Media file 14: A 76-year-old man with left unilateral facial paresis. Note the marked brow ptosis, absence of horizontal forehead rhytides, and lower eyelid paralytic ectropion. This patient is an ideal candidate for midforehead browlift, gold weight placement, and ectropion repair.
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A 76-year-old man with left unilateral facial par...

A 76-year-old man with left unilateral facial paresis. Note the marked brow ptosis, absence of horizontal forehead rhytides, and lower eyelid paralytic ectropion. This patient is an ideal candidate for midforehead browlift, gold weight placement, and ectropion repair.

A: Preoperative view of a 52-year-old woman who d...
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Media file 15: A: Preoperative view of a 52-year-old woman who desires browplasty. The patient did not want sedation or general anesthesia. A midforehead browlift was performed with local anesthesia. The authors usually reserve the midforehead browlift for men with deep horizontal forehead rhytides. B: Three months status post midforehead browlift. Note the well-healed forehead incisions. Dermabrasion, although not used in this patient, may improve scar camouflage.
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A: Preoperative view of a 52-year-old woman who d...

A: Preoperative view of a 52-year-old woman who desires browplasty. The patient did not want sedation or general anesthesia. A midforehead browlift was performed with local anesthesia. The authors usually reserve the midforehead browlift for men with deep horizontal forehead rhytides. B: Three months status post midforehead browlift. Note the well-healed forehead incisions. Dermabrasion, although not used in this patient, may improve scar camouflage.

A: Elderly patient with paralytic brow ptosis on ...
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Media file 16: A: Elderly patient with paralytic brow ptosis on right (note hyperactive left frontalis muscle). B: Early postoperative result demonstrating improved brow symmetry. The left frontalis muscle is no longer overcompensating. C: Staggered fusiform incisions and proposed site of suspension sutures. D: orbicularis oculi fibers identified prior to brow suspension.
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A: Elderly patient with paralytic brow ptosis on ...

A: Elderly patient with paralytic brow ptosis on right (note hyperactive left frontalis muscle). B: Early postoperative result demonstrating improved brow symmetry. The left frontalis muscle is no longer overcompensating. C: Staggered fusiform incisions and proposed site of suspension sutures. D: orbicularis oculi fibers identified prior to brow suspension.

Preoperative frontal view of a patient with brow ...
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Media file 17: Preoperative frontal view of a patient with brow ptosis and dermatochalasis prior to endoscopic browlift and lower lid blepharoplasties.
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Preoperative frontal view of a patient with brow ...

Preoperative frontal view of a patient with brow ptosis and dermatochalasis prior to endoscopic browlift and lower lid blepharoplasties.

Four-month postoperative view of patient in Image...
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Media file 18: Four-month postoperative view of patient in Image 17. Note mild elevation in hairline that is invariably observed following endoscopic and coronal browlift procedures. The patient was counseled about the hairline change preoperatively.
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Four-month postoperative view of patient in Image...

Four-month postoperative view of patient in Image 17. Note mild elevation in hairline that is invariably observed following endoscopic and coronal browlift procedures. The patient was counseled about the hairline change preoperatively.

This is a 50-year-old woman prior to endoscopic b...
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Media file 19: This is a 50-year-old woman prior to endoscopic browlift, carbon dioxide laser resurfacing, and botulinum toxin injection of periorbital rhytides (preoperatively).
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This is a 50-year-old woman prior to endoscopic b...

This is a 50-year-old woman prior to endoscopic browlift, carbon dioxide laser resurfacing, and botulinum toxin injection of periorbital rhytides (preoperatively).

Six-month postoperative view of woman in Image 19.
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Media file 20: Six-month postoperative view of woman in Image 19.
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Six-month postoperative view of woman in Image 19.

Six-month postoperative view of woman in Image 19.

Endoscopic view of right supraorbital neurovascul...
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Media file 21: Endoscopic view of right supraorbital neurovascular bundle. Note the relatively bloodless subperiosteal dissection plane.
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Endoscopic view of right supraorbital neurovascul...

Endoscopic view of right supraorbital neurovascular bundle. Note the relatively bloodless subperiosteal dissection plane.

Endoscopic view of right supraorbital nerve follo...
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Media file 22: Endoscopic view of right supraorbital nerve following periosteal release.
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Endoscopic view of right supraorbital nerve follo...

Endoscopic view of right supraorbital nerve following periosteal release.

Bulky dressing seen immediately upon completion o...
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Media file 23: Bulky dressing seen immediately upon completion of trichophytic browlift.
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Bulky dressing seen immediately upon completion o...

Bulky dressing seen immediately upon completion of trichophytic browlift.

More on Browplasty

Overview: Browplasty
Workup: Browplasty
Treatment: Browplasty
Follow-up: Browplasty
Multimedia: Browplasty
References
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References

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  2. Nahm WK, Su TT, Rotunda AM, et al. Objective changes in brow position, superior palpebral crease, peak angle of the eyebrow, and jowl surface area after volumetric radiofrequency treatments to half of the face. Dermatol Surg. Jun 2004;30(6):922-8; discussion 928. [Medline].

  3. Ahn MS, Catten M, Maas CS. Temporal brow lift using botulinum toxin A. Plast Reconstr Surg. Mar 2000;105(3):1129-35; discussion 1136-9. [Medline].

  4. Brennan HG. The forehead lift. Otolaryngol Clin North Am. May 1980;13(2):209-23. [Medline].

  5. Burns JA. Thermage: Monopolar radiofrequency. Aesthetic Surg Jour. 2005;25(6):638-642.

  6. Cohen SA, Baker SR. Management of the upper third of the aging face. In: Myers EN, Bluestone CB, Brackman DE, Krause CJ, eds. Advances in Otolaryngology-Head and Neck Surgery. Vol 8. Chicago, Ill: Mosby-Year Book; 1994:69-90.

  7. Coleman, SR. Supraorbital area: brow, upper eyelids and temples. In: Structural Fat Grafting. St. Louis, Missouri: Qualtiy Medical Publishing; 2004:353-400.

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  14. Humble G, Mest D. Soft tissue augmentation using sculptra. Facial Plast Surg. May 2004;20(2):157-63. [Medline].

  15. Isse NG. Endoscopic facial rejuvenation. Clin Plast Surg. Apr 1997;24(2):213-31. [Medline].

  16. Isse NG. Endoscopic forehead lift. Evolution and update. Clin Plast Surg. Oct 1995;22(4):661-73. [Medline].

  17. Johnson CM Jr, Waldman SR. Midforehead lift. Arch Otolaryngol. Mar 1983;109(3):155-9. [Medline].

  18. Koch RJ. Endoscopic browlift is the preferred approach for rejuvenation of the upper third of the face. Arch Otolaryngol Head Neck Surg. Jan 2001;127(1):87-90. [Medline].

  19. Larrabee WF, Makielski KH. Forehead and brow. In: Surgical Anatomy of the Face. New York, NY: Raven Press; 1993:123-128.

  20. Matarasso SL, Carruthers JD, Jewell ML. Consensus recommendations for soft-tissue augmentation with nonanimal stabilized hyaluronic acid (Restylane). Plast Reconstr Surg. Mar 2006;117(3 Suppl):3S-34S; discussion 35S-43S. [Medline].

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  22. Rafaty FM, Brennan HG. Current concepts of browpexy. Arch Otolaryngol. Mar 1983;109(3):152-4. [Medline].

  23. Ramirez OM. Why I prefer the endoscopic forehead lift. Plast Reconstr Surg. Sep 1997;100(4):1033-9; discussion 1043-6. [Medline].

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  25. Valantin MA, Aubron-Olivier C, Ghosn J, et al. Polylactic acid implants (New-Fill) to correct facial lipoatrophy in HIV-infected patients: results of the open-label study VEGA. AIDS. Nov 21 2003;17(17):2471-7. [Medline].

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Further Reading

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Keywords

browplasty, forehead lift, browlift, brow lift, brow plasty, browpexy, brow plexy, direct browlift, temporal lift, endoscopic browlift, transpalpebral browlift, brow ptosis, midforehead browlift, mid forehead browlift, facial aging, cosmetic surgery, brow rejuvenation surgery, brow rejuvenation, forehead surgery, brow rhytid, brow rhytide, rhytids, rhytides, forehead wrinkles, brow wrinkles, facial aesthetic procedure, facial aesthetic surgery

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Contributor Information and Disclosures

Author

J David Kriet, MD, FACS, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Director of Facial Plastic and Reconstructive Surgery, University of Kansas School of Medicine
J David Kriet, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, AO Foundation, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Paulino E Goco, MD, Consulting Staff, Division of Facial Plastic and Reconstructive Surgery, Middle Tennessee Ear, Nose and Throat
Paulino E Goco, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

Medical Editor

Jaime R Garza, MD, DDS, FACS, Consulting Staff, Private Practice
Jaime R Garza, MD, DDS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Allergan Honoraria Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Dominique Dorion, MD, MSc, FRCSC, Program Director and Division Chair, Professor of Surgery, Division of Otolaryngology, University of Sherbrooke, Canada
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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