Orbicularis depressor excision,
internal browpexy and
transblepharoplasty brow lifting
These are relatively simple procedures which are usually performed at the same time as upper eyelid cosmetic surgery (blepharoplasty). They have the advantage of being minimally invasive, using the same incision as the eyelid operation, hidden and invisible within the natural skin crease. Thus there are no additional scars and the recovery time is often very, very quick.
Oribicularis depressor excision involves removing a tiny strip of orbicularis muscle which attaches to the tail of the eyebrow causing it to depress. Removing this little strip weakens the depressor action of the orbicularis muscle, allowing the eyebrow tail to elevate slightly.
Internal browpexy involves elevating the eyebrow by releasing from the underlying tissue and securing it to the periosteum (lining of the bone) of the forehead using a suture. This is relatively quick to perform and is fairly inexpensive. Although an internal browpexy does not elevate the eyebrow substantially, it is often very useful in stabilising the eyebrow, allowing safe blepharoplasty surgery.
Before and 1 week after combined bilateral upper lid internal browpexy and bilateral upper lid blepharoplasty. This lady complained of hooding of her upper lids. Her eyebrows were so unstable, that eyelid surgery on its own would have resulted in further descent of the eyebrow. The eyebrow was therefore stabilised by using a suture to secure it to the underlying lining of the forehead bone (internal browpexy). Notice that even after only 1 week, much of the postoperative swelling has already disappeared.
Transblepharoplasty brow lift is similar to an internal browpexy but the instead of using a suture, a dissolving implant is used to help more securely elevate the brow.
The bone underlying the eyebrow is gently exposed and a tiny partial thickness hole is made in the outer layer of it. The implant is then clicked into into this hole. Three hooks on the 'Endotine' transblepharoplasty implant engage the overlying soft tissue of the eyebrow and prop up the eyebrow. The implant the provides a secure convenient support for the eyebrow and overlying forehead tissues and slowly dissolves away over the next 3-4 months to become impalpable.
Before (left) and 6 weeks after (right) bilateral upper lid blepharoplasty and transblepharoplasty brow lifting. This lady was complaining of very heavy eyebrows, headaches and the inability to see properly because of her hooded upper lids. Notice the improved eyebrow position and shape. Previously the outer tail of her eyebrows were droopy. With a combined brow lift and blepharoplasty, both her eyebrows and eyelids assume a better shape and no longer compromise her visual field.
Blepharoplasty surgery alone would not have sufficed in this lady, since she would have required extensive skin excision to remove the excess skin, resulting in eyelid skin shortage, a cosmetically poor eyelid and potentially the inability to close her eyelids properly.
This procedure is one of our most popular procedures due to its cost, relatively short procedure time and very quick recovery. Many of Mr Cheung's patients request this procedure since it can be quickly and comfortably performed, even under local anaesthetic as a day case, thereby minimising costs.
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