Enhancing upper lid aesthetics with the lateral subcutaneous brow lift

Abstract

Surgical techniques for improving the upper eyelid aesthetic unit have recently focused on the management of eyebrow position. In our practice, we noticed that in some patients the lateral brow was low preoperatively, whereas in others it was well positioned but overly mobile. We describe our experience using the lateral subcutaneous brow lift (LSBL) to elevate and stabilize the lateral brow. An incision was marked at the junction of the hair-bearing scalp and forehead, beginning on a line extending superiorly from the mid-pupillary line, and carried down to the subcutaneous plane, just superficial to the frontalis muscle. The subcutaneous tissues were dissected from the frontalis muscle, and the skin and subcutaneous flap were retracted superiorly. The flap was divided vertically, a skin staple was placed, and after assessment of brow position and stability, the medial and lateral excess skin was excised. Tisseel (Baxter Hyland Immuno, Glendale, CA) was found to facilitate hemostasis and, to a lesser extent, flap adherence. At the end of the procedure, the brow was slightly overcorrected to compensate for some postoperative descent. If planned, an upper blepharoplasty was performed in the standard fashion. The LSBL was performed in 117 patients during a 2-year period; in 82 of these cases the brow lift was performed in conjunction with upper lid blepharoplasty, and in 31 cases it was performed as part of a facial rejuvenation procedure that did not include upper eyelids. All patients reported their scars as imperceptible. Complications included 2 hematomas and 6 cases of hypesthesia confined to the region just posterior to the incision; all resolved within 8 weeks. In 1 case, the flap was inadvertently torn during its elevation; it was repaired and did not affect the outcome. The LSBL is a safe and technically simple technique that allowed us to achieve optimal aesthetic results in the upper periorbita with few complications and a high patient acceptance rate.