Browlift, or forehead lift, procedures are performed to raise eyebrows to a higher more youthful position.
As a consequence of a browlift, the hanging of excess upper eyelid skin will become reduced, and therefore, may reduce the need for, or modify the type of upper eyelidplasty that might otherwise have been considered. Therefore, brow position is an essential part of the evaluation of a patient who is requesting an upper eylidplasty.
The classical forehead lift with an incision across the top of the head from ear to ear is rarely performed as newer techniques offer many advantages.
Current techniques include a variety of endoscopic browlifts, anterior hairline forehead lifts, posterior hairline forehead lifts, direct forehead skin excision browlift, transblepharoplasty incision browlift, with the use of absorbable endotines suspension devices, or the use of suspension sutures.
Endoscopic Browlift, also know as “Endo Browlift”, is a type of forehead lift performed through small posterior hairline incisions with the use of a fiberoptic scope with TV monitor to view the dissection and manipulation of tissues to free up skin attachments, remove, or partially remove muscles that cause forehead wrinkles using narrow instruments.
Once the elevation of the brows and treatment of the glabellar frown muscles is achieved, the short scalp wounds are closed, and may be suspended with sutures, absorbable pegs, Forehead Endotine device, or removal screws to hold the brows in place until fully healed.
Posterior Hairline Browlift
Posterior Hairline Browlift is performed through a short incision using narrow instruments without the fiberoptic endoscope. The forehead skin muscle and fibrous tissues are dissected to the rim of the eye sockets freeing the brow and allowing it to be pulled up to correct the drooping. Some scalp skin may be excised behind the hairline, and secured with long acting, or permanent sutures to maintain the elevated position until healing has occurred.
This technique has the advantages of short scars like the endoscopic browlift, but without the need for the endoscope. However, it doesn’t treat the glabellar frown lines between the eyebrows. These may be addressed by direct excision of the frown muscles via the wrinkles, or through the upper eyelid incision, if an upper eyelidplasty is also being done.
Transblepharoplasty Incision Browlift
The transblepharoplasty technique is useful in patients with mild brow ptosis, who also need an upper eyelidplasty to treat skin and fat excess in the upper eyelid.
Transblepharoplasty Incision Browlift utilizes the upper eyelid incision to release the brow attachment from the rim of the eye socket, then the brow can be secured in its new elevated position with sutures, or with and Endotine, which is a cleat-like device designed to be used above the brow.
The Transblepharoplasty Endotine Technique
Endotine on applicator Endotine device
Transblepharoplasty Endotine Browlift Technique Summary
An upper eyelidplasty incision is made and then dissected to the area above the eye socket rim. The wound is then deepened and the brow tissues are approached subperiosteally, against the bone. The brow is released from its attachments to create adequate mobility, and allow lifting it into a higher position.
An anchoring hole for the ENDOTINE TransBleph is drilled in the frontal bone using the self-stopping drill bit.
The Endotine implant is locked into the drill hole holding it securely in place in the frontal bone.
The implant is released from the insertion tool.
Elevate the periosteum to achieve the desired brow height. Use digital pressure to engage the brow tissues, and hold then in place.
The incision is closed with sutures, and a compression bandage is applied.