Forehead or Brow Lift

Our Signature Procedure: The Dual Plane Brow Lift

Nothing else in the human face carries more emotional impact that the eye's and brow's expression. Proper eyebrow positioning is often essential in the correction of the aging eye. Often as we age, our brows descend, creating a tired or worried look. The goal of brow lifting is to restore the posture and contour of the eyebrow and rejuvenate the eye expression.

Before	After
53 years old, Browlift w/Fat injections to Cheek and Cheekbone Area, post op picture taken 1 month(s) after procedure

A brow or forehead lift also smooths the forehead, raises the upper eyelids, and minimizes the frown lines that come with aging. It also improves the sagging appearance around the outer aspects of the brow. Our favorite approach is a modified endoscopic procedure that involves placing a small weaving incision in the scalp or at the hairline, then gently up-lifting the arch of the Brow. Portions of facial muscle affecting the frown lines are removed. Integrated in the hairline, the scars are usually well disguised. The results can be stunning, restoring a dynamism, elegance and beauty to t the eye's expression, changing ones perception of the patient's mood and amazingly often affecting the patient's mood itself!

A once popular and inexpensive procedure that is advertised to replace the brow lift is called the thread brow lift. These procedures most often result in marginal or temporary benefits, but it also has had many complications. At the Clinique of Plastic Surgery, we can show you pictures of many corrections that we have done on patients who had thread lifts procedures that had to be corrected with a proper brow or face lift. Like everything else in life, a surgical procedure that sounds too good to be true, usually is.

This procedure can be done under intravenous (local) anesthesia or general anesthesia and takes about an hour or less. Most people can return to work within a week or less.

Computer imaging is offered at the Clinique of Plastic Surgery and is an excellent tool to help you visualize anticipated results.

Before	After
50 years old, Refresher lift, neck lift, brow lift, post op picture taken 3 month(s) after procedure
Before	After
54 years old, limited brow lift, post op picture taken 3 month(s) after procedure
Before	After
52 years old, Refresher Facelift w/Fat Injections to Cheeks, Neck Plication w/Chin Implant, Browlift & Rhinoplasty, post op picture taken 6 month(s) after procedure
Before	After
52 years old, post op picture taken 1 month(s) after procedure
brow lift, fat injections to cheeks and lips, TCA peel
Before	After
50 years old, post op picture taken 6 month(s) after procedure
brow lift and liposuction of neck
Before	After
53 years old, Browlift w/Fat injections to Cheek and Cheekbone Area, post op picture taken 1 month(s) after procedure

The Dual Plane Brow Lift Technical Explanation From Dr. Drehsen

Dissatisfied by the somewhat unnatural elevation of the brows as well as the posterior displacement of the hairline often seen in endoscopic approaches, as well as the disturbing scalp incision and the substantial relapse of the brow ptosis in a number of coronal lift, I have for over 10 years developed an alternative procedure; the dual plane brow lift (DPBL)

2 principles guided my search:

-A receding hairline is not a youthful hairline

-Like the frame of a painting, the brow extols the beauty of an eye; there are no preset esthetic distances between iris and eyebrow. In female esthetics the brow posture should espouse the slant of the eye.

The forehead skin uplift should therefore occur often anterior to the hairline.

The brow position should be predictably controlled

Hence the DPBL!

Key points of the technique:

A wavy sharply beveled intra or retro trichial or combination gull wing incision is performed according to the desired height of the frontal hairline, its individual shape, and the quality of the temporal hair implantation.

After an extensive dissector undermining, the forehead skin is detached from the frontalis muscle for a distance of 4 to 5 cm. Two parallel vertical incisions at about the mid papillary line are performed with the back of a 10 blade into the upper frontalis muscle. The underlying frontal periosteum is reflected with elevators and a single suspension tunnel is done on each side with a high speed Microaire drill. The muscle is then elevated bluntly with scissors at the subgaleal level and the periorbitum is reached under direct vision. A careful detachment is done with scissors and punch, preserving the medial retaining ligaments, nerves, and vessels.

The corrugators and procerus are avulsed with the punch. The periorbitum, now mobile, will be uplifted with 2 or 3 retaining 3.0 Mersilene loops passed thru each cortical tunnel. Location of the suspension points is done by a manual uplifting of the mobile brow to determine optimal soft tissue placement and percutaneous transfixion with Keith needles, perpendicular to the brow, to allow easy location of the suspension sites. The most medial sutures grasp the thick subcutaneous padding of the medial brow. The lateral suture(s) grasp the soft tissue of the frontalis/brow pad junction, often accessed by a tunneling dissection in the subcutaneous plane and demonstrated by grasping the lower frontalis with forceps to assess its mechanical effect on the lateral brow elevation. A transfixing suspension suture is placed into that junction. A constant assessment of possible brow puckering is done after each suture placement, and the suture is replaced until no more than a minimal depression is observed.

The sutures are tied snug enough to produce the desired brow uplift. The vertical muscle incisions are closed with 4.0 Monocryl. The undermined skin and scalp are advanced with a single 40 Monocryl suture attached to the medial temporalis fascia. A wavy beveled strip of skin and scalp is excised. The scalp is closed with a running interlocked 50 nylon, the skin with a near/far running 50 Chromic. A small drain is sometime used. A compressive head band is applied.

Results

Of over 200 cases performed over more than 10 years, no permanent motor deficit has occurred, no infection, no skin loss, no hair loss, and rare limited touch ups to address unsatisfactory scars or minimal asymmetry. Recovery occurs in 5 or 6 days. Maturation of the hairline scar occurs within 6 months. Less itching and hypoesthesia has been observed due to the preservation of most of the vertical sensory fascicles. Touch-ups have been very rare and limited. Satisfaction has been impressive whether it regards the improved facial aura, the permanency of the repair, the more youthful expression, or the virtual undetectability of the scars.

For a personal and confidential consultation with one of our Board Certified Plastic Surgeons, call the Clinique of Plastic Surgery at 800-942-1606 to schedule your appointment today!

As with any medical procedure, there are certain inherent risks that should be discussed. Costs vary depending upon the extent of the surgery and areas treated.