Part III Periorbital Rejuvenation

Sammy Sinno and Charles H. Thorne

Abstract

For patients with thin skin and lateral brow ptosis, a subcutaneous temporal brow lift employing a zig-zag hairline incision is an extremely effective technique to improve brow position and shape.

Brow ptosis – temporal brow lift – zig-zag incision – brow laxity – subcutaneous dissection

37 Brow and Forehead: Subcutaneous Temporal Brow Lift

Key Points

This technique does not address the medial brow. Most patients require lateral brow elevation only.
The ideal candidate is one with significant brow laxity and thin skin.
The forehead skin is redraped in the vertical direction along the incision, making sure to preserve the zig-zag nature of the closure.

37.1 Preoperative Steps

The ideal patient is an elderly patient with Fitzpatrick skin type I or II.
The procedure is performed via a zig-zag incision along the vertical portion of the temporal hairline. The technique requires excision of dog-ears along the transverse portion of the temporal hairline and along a portion of the frontal hairline (Fig. 37.1).
The technique does not address the medial brow.
The goal is to elevate the lateral brow to a level approximately equal to that of the medial brow.
Elevating the medial brow necessitates an even greater degree of lateral brow elevation to achieve an aesthetically pleasing brow shape.
The technique is often performed in combination with standard upper blepharoplasty.
If a facelift is performed concomitantly, the brow and face incisions are not continuous unless a prehairline incision is used for the face.

37.1.1 Temporal Access and Dissection

Local anesthesia is infiltrated in all areas of planned dissection.
After 10 minutes, a #15 blade is used to make the zig-zag incision.
The skin and subcutaneous tissue are raised off the superficial surface of the frontalis muscle for several centimeters using a #10 blade.
When convenient, a lighted retractor is inserted, and the dissection is continued inferiorly to the region of the brow using scissors.
Dissection is lateral to the supraorbital nerve branches.
The elevation is complete when the entire lateral brow is freely mobile. Typically, dissection just below the lateral brow is required (Fig. 37.2).