Part III Periorbital Rejuvenation

Rod J. Rohrich and Min-Jeong Cho

Abstract

The goal of brow rejuvenation is to restore a youthful appearance of the brow and forehead. Plastic surgeons have several options to perform brow lift: direct, endoscopic, hairline, lateral, temporal, and transblepharoplasty brow lift. In this chapter, we discuss the endotemporal brow lift, which combines the strength of endoscopic and temporal brow lift techniques. This technique allows plastic surgeons to treat both medial and lateral brow ptosis in patients with mild to moderate brow ptosis.

Brow rejuvenation – brow lift – endotemporal brow lift – endoscopic brow lift – temporal brow lift

34 Brow and Forehead: Endotemporal Brow Lift

Key Points

Endotemporal brow lift combines the advantages of the endoscopic and temporal brow lift approach.
It offers treatment for both medial and lateral brow ptosis.

34.1 Preoperative Steps

Analysis:
- The brow rejuvenation procedure begins with a comprehensive preoperative facial analysis including horizontal thirds and vertical fifths.
- Patients with the following are candidates for the endotemporal brow lift:
  - Female: Mild/moderate rhytides with a short forehead.
  - Male: A long forehead with sparse hair.

34.2 Operative Steps

Prior to draping, proposed operative sites are injected with 30 mL of 0.25% of xylocaine with 1:400,000 epinephrine.

34.2.1 Incision Placement

First, a 6 cm horizontal incision is drawn 5 cm posterior to the temporal hairline (Fig. 34.1). This incision will serve as a temporal port.
Then, a 2 cm vertical incision is drawn at the midline (Fig. 34.1). This incision will serve as an anterior port.

**Fig. 34.1** Incisions for anterior and temporal port.

34.2.2 Temporal Brow Elevation

The scalp is incised while beveling to prevent damage to the deep hair follicles.
The scalp is elevated in a subgaleal plane using a periosteal elevator.
Dissection is continued caudally in the subgaleal plane superficial to the deep temporal fascia (Fig. 34.2).
At the supraorbital rim, the orbital retaining ligament is released. Then, the zone of adhesion at the temporal fusion line and the temporal ligamentous adhesions are released. The medial extent of the dissection stops at the lateral two-thirds of the brow (Fig. 34.3).