Direct brow lift, temporal (pretrichial) lift, direct forehead lift and coronal brow lifts
Although these techniques of brow lift have been around the longest, they still have a significant role to play in modern surgery. They all have in common the fact that they are excisional techniques, where a strip of tissue above the eyebrow to be lifted is excised (removed). Because of this, they allow for significant amounts of brow lifting and are still considered to be the longest lasting of all the brow lifiting techniques. The main disadvantage of excisional techniques is that a skin scar is created. However, the scar often becomes inconspicuous/ invisible.
For these reasons, excisional techniques have a major role to play in severely drooping eyebrows/foreheads often due to pathological conditions e.g. damage to the nerves supplying the facial muscles, where significant reliable amounts of lifting are commonly necessary.
- Direct brow lift involves the removal of skin just above the eyebrow and is mainly used in older patients or patients with severe brow ptosis, commonly due to facial nerve damage. The incision scar will often look like normal forehead wrinkles in time or disappear outright. A direct brow lift not only has the advantage of being the most effective and predictable method of lifting a ptotic eyebrow, but also has the side effect of smoothing out the forehead furrows slightly by pulling it downwards towards the eye. This leads to an ironing out the forehead furrows and a pulling down of the hairline slightly, which is particularly useful in patients with a high hairline. Care is taken to try and hide the incision just above the eyebrow hairs.
This gentleman had a severely drooping left eyebrow due to paralysis of one of the nerves of the forehead (left). A direct brow lift has been performed by removing a thin strip of skin and muscle from above the eyebrow. Here the amount of skin to be removed has been marked out (middle). A fine scar still remains at 4 months following surgery but this often becomes so fine it either becomes invisible or resembles a normal forehead wrinkle (right)
- A temporal (pretrichial) brow lift is useful for a patient who requires a moderate lift of the outer aspect of the eyebrow only. The incision is made in the temple just behind the hairline and involves the removal of a strip of hair-bearing skin.
- Direct forehead lift involves removing a strip of forehead skin and muscle. Usually performed in men older than 50 due them commonly having pre-existing deep forehead furrows, the incisional scar is hidden within a forehead line. Although initially quite visible, the postoperative scar fades away over time to resemble a normal forehead wrinkle.
- The coronal forehead and brow lift is the most invasive approach to brow lifting. This involves a large incision running across the scalp a few centimetres behind the hairline. Although considered outdated, this approach still has a significant role in patients with a marked brow ptosis. The disadvantages of this approach are the scar and potential permanent numbness of the scalp behind the scar which extends to the centre of the scalp.