Direct Brow Lift

Direct Brow Lift

Tom D. Wang


The direct brow lift is one of several effective methods to surgically reposition the brow and rejuvenate the upper face. It is one of the most straightforward surgical approaches for managing brow ptosis due to aging or facial nerve paresis. Aging results in loss of skin elasticity, decreased bulk of subcutaneous tissue, and resorption of the skull bone. Together, these factors contribute to the development of forehead and eyebrow ptosis. These changes are usually first seen in the region of the lateral eyebrow. This is due in part to the agonist/antagonist relationship between the brow elevator (frontalis muscle) and the brow depressors (corrugators, depressor supercilii, procerus, and orbicularis muscles). The attachments of the frontalis muscle do not extend laterally beyond the temporal line. Hence, the depressors have unopposed action lateral to this area, and the lateral brow descends to a greater degree than the rest of the brow.

Brow ptosis is also a common sequelae of facial paralysis and in this setting may cause significant upper eyelid hooding and impairment of the superior visual field. To an observer, these changes in brow position, regardless of cause, convey a conception of fatigue, tiredness, and lethargy, despite good rest, energy, and health. In the aging face, brow lift aims to restore a more youthful appearance, while conveying a more rested and vigorous image. In the patient with facial paresis, brow lift serves to restore brow position and symmetry; these components are important to both facial recognition and relieving possible blockage of the visual fields.

Effective rejuvenation of the upper face, or paresis, requires a thorough understanding of aesthetics of the forehead and brow. The youthful forehead of a female is generally smooth and without significant rhytids. The male forehead may have shallow glabellar furrows and soft horizontal rhytids while still appearing youthful. While the aesthetics of the ideal upper brow is debatable, no universally accepted rule exists. However, it is generally accepted that in females, the brow should arch superolaterally, with an apex in line with the lateral limbus or the lateral canthus. The medial extent of the brow should abut a line vertically tangent to the lateral nasal ala, and the lateral extent should approximate an oblique line drawn from the nasal ala through the lateral canthus. In females, the youthful brow should be arched and lie just above the supraorbital rim. In males, the youthful brow position and contour are flatter without the high arching lateral aspect and should sit at the supraorbital rim.

Advantages of the direct brow lift include the following:

  • Easy to perform

  • Relatively direct control of brow position

  • Limited risk to supraorbital, supratrochlear, and facial nerve

  • Low risk of hematoma

  • A long-lasting lift from orbicularis oculi suspension

Disadvantages of the direct brow lift include the following:

  • Presence of a prominent, conspicuous scar on the forehead.

  • Inability to address forehead and glabellar rhytids.

  • It is difficult to achieve elevation and contouring of the medial portion of the brow.

  • Placement of suspension sutures to a superior position on the periosteum is difficult.

Oct 4, 2018 | Posted by in OTOLARYNGOLOGY | Comments Off on Direct Brow Lift

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