Brow Lift Technique Research Articles

Brow lift practice in receding hairlines: A retrospective comparison of brow lift techniques

IntroductionAssessing facial aesthetic surgery outcomes often relies on expert opinion, which inherently introduces bias. This study examines the use of artificial intelligence (AI) to objectively compare novel and standard brow lift techniques. MethodsFifty-nine patients underwent brow lift surgery between 2006 and 2020 and were divided into two groups: Group A (n=47) underwent a standard brow lift, while Group B (n=12) received our novel technique. Patients were excluded if they underwent a simultaneous rhytidectomy or if their images were unreadable by the software. AI analysis examined emotion and action unit functioning, and then was correlated to manual measurements of brow position. ResultsGroup A demonstrated an increase in happiness from 1.6% to 9.5% (p=0.004), a decrease in sadness from 14.9% to 8.0% (p=0.06), and a decrease in anger from 14.8% to 5.7% (p=0.007). Group B experienced an increase in happiness from 5.2% to 12.6% (p=0.18), a decrease in sadness from 18.9% to 10.3% (p=0.1), and a decrease in anger from 26.4% to 10.9% (p=0.07). Group A exhibited elevation in brow position by 2.3-3.7mm (p<0.05) and a decrease in brow lowerer action unit functioning from 17.8% to 3.8% (p=0.0005). Group B exhibited elevation in brow position by 2.78-5.05mm (p<0.05) and a decrease in brow lowerer action unit functioning from 35% to 8.4% (p=0.011). ConclusionThis study demonstrated similar efficacy of the examined brow lift techniques for causing positive emotional changing while elevating the brow. This objective comparison demonstrates the utility of artificial intelligence in assessing facial surgery.

A new minimally invasive, nonexcisional, surgical browlift technique with minimal scarring: a protocol for a prospective observational study.

The aim of this study is to prospectively evaluate the new minimal invasive (MINE) browlift technique with possibly superior results and minimal visible scarring. A prospective observational study will be performed on all available data from patients who will undergo a browlift procedure in the HMC from 1 June 2021 till 31 May 2024. Our goal is to include at least 50 patients. Inclusion criteria are: patients with medical (i.e. brow ptosis and facial paralysis) or cosmetic indication, patients with sufficient understanding of the Dutch or English language and willingness to participate in extra study specific follow-up moments and filling in of questionnaires. Exclusion criteria are: less than 18 years of age and patients with previous brow or eyelid surgery. Patients will be photographed preoperatively and postoperatively using the VECTRA camera. Scarring after procedure; functionality of eyebrow movement; amount of correction in brow ptosis, measured in VECTRA; longevity of procedure in months; aesthetic result as assessed by questionnaires and adverse effects of procedure will be measured. The database management software 'Castor' will be used to store and collect the data from the questionnaire. The Medical Research Ethics Committee found this study not eligible to be submitted to the Dutch Medical Research Involving Human Subjects Acts (WMO). Written consent will be obtained from all patients.

Direct brow lift surgical technique and new eyebrow aesthetic optimization model

The fascination with beauty attracts optimizations of surgical techniques. The eyelid-eyebrow region forms the emotional and expressive center of the human face. Aging causes a decrease in skin elasticity, allowing soft tissues to sag with gravity [1,2]. In this sense, surgical eyebrow lifts to improve aesthetics of the upper third of the aging face have been performed for several years. Current brow lift methods include direct brow lift, mid-forehead lift, coronal brow lift, and endoscopic brow lift [3-5]. Therefore, this technical article presents an optimization of the treatment of eyebrow tail ptosis using the modified direct brow lift technique by direct eyebrow elevation.

Objective Comparison of Eyebrow Position after Internal and External Browpexy.

Several brow-lift techniques have been used to prevent brow ptosis after blepharoplasty. For example, both internal and external browpexies have been adopted worldwide. However, few studies have compared these two methods. The authors compared postoperative eyebrow position changes between upper eyelid skin excision, internal browpexy, and external browpexy. The authors retrospectively reviewed the cases of 87 patients who underwent upper blepharoplasty performed by a single clinician at their institute between April of 2018 and June of 2020. Patients with routine outpatient photographs taken before and after surgery were enrolled in the study. ImageJ was used to measure brow height at eight points in each eye. Brow height changes were compared among the three groups. Routine photographs were available for 68 patients (133 eyes). Thirty-nine patients underwent internal browpexy (78 eyes), nine underwent external browpexy (17 eyes), and 20 underwent upper eyelid skin excisions (38 eyes). Three months after surgery, significant elevation was noted on the lateral side of the brow in the internal browpexy group and across the whole brow in the external browpexy group. In the upper eyelid skin excision group, whole brow ptosis was observed. Brow-lift outcomes were better in the external than in the internal browpexy group, whereas both browpexy groups showed better outcomes than the upper eyelid skin excision group. Within 3 months of surgery, both internal and external browpexy provided significant brow-lift effects, preventing brow ptosis caused by blepharoplasty with skin excision. External browpexy had better brow-lift outcomes than did internal browpexy. Therapeutic, III.

SUBKÜTAN KAŞ KALDIRMA CERRAHİSİNİN EVRİMİ: SONUÇLARIN VE KOMPLİKASYONLARIN KARŞILAŞTIRMALI ANALİZİ

Aim: This study aims to analyze and compare the results of three different subcutaneous brow lift techniques: Fogli temporal lift, pretrichial brow lift, and gliding brow lift.&#x0D; Material and methods: Thirty-three female patients underwent brow lift surgery between July 2022 and September 2021. Initially, eighteen consecutive patients were operated with either the temporal lift technique or pretrichial brow lift technique based on their forehead length. Then, fifteen consecutive patients underwent the gliding brow lift surgery regardless of their forehead length. Age, type of anesthesia, other accompanying surgical procedures, and postoperative complications including presthesia in the scalp, incisional postoperative healing problems, unfavorable incisional scarring, non-incisional healing problems, hypopigmentation, hyperpigmentation, neuropraxia of the frontal branch, recurrence, and hematoma were analyzed based on the type of the brow lift technique retrospectively.&#x0D; Results: The average follow-up period was 13.6 months (range, 9-21 months). In the gliding brow lift, the most common complications were transient scalp paresthesia (47%), non-incisional healing problems (27%), and small areas of hypopigmentation in the forehead skin (20%). The most common complications of the temporal lift were the unfavorable incisional scarring (85%) and transient (77%) or permanent (31%) paresthesia in the scalp. The rate of postoperative small incisional problems (80%) and scarring (60%) were high in the pretrichial subcutaneous brow lift. None of the patients required a revision surgery or had a permanent frontal branch injury.&#x0D; Conclusion: There has been a trend toward the minimally invasive techniques in periorbital rejuvenation. The ideal technique should have minimal morbidity and provide long-lasting effects. This study demonstrates that the gliding brow lift technique is a promising and minimally invasive technique with pleasing outcomes in brow rejuvenation.

One-year sustainability of brow-lifting procedures

Unlike blepharoplasty or facelifting procedures, there is little evidence of the sustainability of brow-lifting techniques. This study aimed to investigate the one-year sustainability of three brow-lifting techniques performed at our department. Thirty-six patients received an upper blepharoplasty and simultaneously one of three brow-lifting procedures: the direct (excisional) browpexy, the transpalpebral brow lift, and the EndotineⓇ forehead fixation. analogue and digital measurements of 3 vertical distances, from fixed anatomical points at pupil, lateral canthal, and lateral orbital rim level, were performed preoperatively and 12 months postoperatively. Patients' and surgeons' satisfaction considering functional and aesthetic outcomes were investigated by carrying out paper-pencil surveys. Direct browpexy was performed in 8, transpalpebral eyebrow lift in 10, and the EndotineⓇ fixation in 18 of the cases. In the first year, direct browpexy showed a general descent of 1.2mm at the pupil level, 2.1mm at the lateral canthal, and 0.6mm at the orbital rim level. In the transpalpebral eyebrow lift group, a descent of 0.7mm at the pupil level and 0.3mm at the lateral canthal level was found; the orbital rim level showed a slight but nonsignificant ascent of 0.7mm. In the EndotineⓇ group, a descent of 1.1mm at the pupil level, 1.2mm at the lateral canthal level, and 0.7mm at the orbital rim level was shown. Subjective surgeon opinions and overall patient satisfaction underline an aesthetic improvement despite objective results falsifying the hypothesis of a raised eyebrow position after one year. Patients showed minor eyebrow decrement after 12 months postoperatively; therefore, sustainability is questioned and must be reevaluated. The extent of dissection, the downward pull of upper blepharoplasty resection, and the decrease in frontalis muscle activity are discussed as the possible causes.

Contemporary Direct Brow Lift With Suspension Technique

Brow ptosis is one of the earliest signs of periorbital aging. To surgically correct the aging brow, several brow lift procedures have been documented with varying amounts of success. Direct brow lift is regaining its popularity as it is a simple direct surgery that allows the surgeon a precise positioning, elevation, and shaping of the brow. However, unaesthetic scarring is a potential handicap of this technique. To reduce scarring, many methods have been proposed from different design markings, beveling the incision, and tissue suspension. The versatility of direct brow lift lies in its design, execution, tissue management, and reduction of tension in the scar. In this article, we present a refined modification of the classic direct brow lift technique. The procedure is based on anatomical landmarks with a versatile and reproducible design, a 20° beveled incision, and periosteal suspension of the orbicularis muscle. In our experience, the use of this technique has enabled us to attain long-term stable aesthetic results.

85. Artificial Intelligence in the Objective Comparison of Endoscopic Browlift Techniques

Purpose: Facial aesthetic surgeries tend to use expert opinion and patient satisfaction as a means for judging success. However, these techniques are inherently influenced by personal bias and subjectivity. This limits the objective comparison of the patient’s outcome over time or outcomes of different surgeries. This study examines the use of the artificial intelligence software: FaceReader, to objectively compare a novel and well established browlift technique. Methods: 66 patients who underwent endoscopic browlift were identified and separated into two groups. Group A (n=52 (2006-2018)) underwent standard endoscopic browlift with hairline incisions. Group B (n=14 (2016-2020) underwent a novel technique of endoscopic browlift. The novel technique involves incisions and forehead anchoring within the forehead crease lines to minimize posterior displacement of the hairline. On average 2 concomitant procedures were performed with the novel technique while on average 1.2 were completed on the pre-existing technique; the most common being blepharoplasty. Patients were excluded if their image could not be run by the software or if they had had a rhytidectomy as a concomitant procedure. This resulted in 46 analyzed patients in Group A and 12 patients in Group B. Pre- and postoperative neutral expression images were then analyzed using FaceReader. The software tracks 500 key locations on the face to accurately measure the presence and intensity of 28 action units and 7 cardinal emotions in each image. Results: Across the procedures, the only emotions the software detected to have changed significantly were perceived happiness, sadness, and anger. Group A had an increase in happiness from 1.63% to 9.45% (p=0.004) while Group B increased from 5.24% to 12.59% (p=0.18). Group A had a decrease in sadness from 14.85% to 7.98% (p=0.06), while Group B decreased from 18.86% to 10.29% (p=0.1). Most significantly anger decreased in Group A from14.76% to 5.74% (p=0.007) with Group B decreasing from 26.41% to 10.88% (p=0.07). To assess the brow position, the brow lowerer action unit results were analyzed. Both groups had significant decrease activity in the action unit: Group A decreased intensity from 17.8% to 3.8% (p=0.0005) and Group B decreased from 35% to 8.4% (p=0.011). These findings report nearly identical relative changes except for happiness which was increased 480% in Group A compared to 140% in Group B. Conclusion: This study provides the proof of concept for the use of artificial intelligence to objectively compare surgical outcomes between two browlift techniques. This study demonstrates that the novel technique of browlift is as effective at brow elevation with similar patterns of alterations in patients’ emotions. Future applications of this software should include large patient population assessment of various facial surgeries to uncover which have the greatest impact on functioning and emotional expression.

A new minimally invasive, non-excisional, surgical browlift technique with minimal scarring: a protocol for a prospective observational study

Background The aim of this study is to prospectively evaluate the new minimal invasive (MINE) browlift technique with possibly superior results and minimal visible scarring. Methods A prospective observational study will be performed on all available data from patients who will undergo a browlift procedure in the Haaglanden Medical Center from 1-6-2021 till 31-5-2022. Our goal is to include at least 50 patients (1 per week). Inclusion criteria are: patients with medical (i.e. brow-ptosis, facial paralysis) or cosmetic indication, patients with sufficient understanding of the Dutch or English language and willingness to participate in extra study specific follow-up moments and filling in of questionnaires. Exclusion criteria are: &lt;18 years of age and patients with previous brow or eyelid surgery. Patients will be photographed pre- and postoperatively using the VECTRA camera. The database management software Castor will be used to store and collect the data from the questionnaire. The Medical Research Ethics Committee found this study not eligible to be submitted to the Dutch Medical Research Involving Human Subjects Acts (WMO). Written informed consent will be obtained from all patients. Results Outcomes measures to be evaluated include: scarring after procedure; functionality of eyebrow movement; amount of correction in brow ptosis, measured in VECTRA; longevity of procedure in months; aesthetic result as assessed by questionnaires; and adverse effects of the procedure.

Endoscopic Browlift in Patients With Receding Hairlines.

Patients with receding or high hairlines have traditionally been considered unfavorable candidates for endoscopic brow lift as this can further lengthen the hairline. We analyzed outcomes in patients that underwent a novel endoscopic brow lift technique with placement of incisions and anchoring Endotine Forehead Devices (CoApt Systems Inc, Palo Alto, CA, USA) directly at the natural forehead crease lines, in an effort to minimize elevation of the hairline, whereas providing well-hidden scars. We retrospectively reviewed all patients who underwent this new Endotine and incision placement between 2016 and 2020. Preoperative and postoperative photographs of all patients were analyzed to determine the postoperative changes in brow elevation and forehead length proportion (defined as length from cranium to chin).The forehead length proportion was unchanged pre- and post-operatively, with no statistically significant differences noted (P = 0.48). The average brow position elevation ranged from 2.78 mm in the medial location to 5.05 mm in the lateral location. All patients were happy with their appearance and had improved visual fields postoperatively. The forehead scars healed well and were well hidden in forehead rhytids at long term follow-up.This novel endoscopic brow lift technique provides an option to utilize a minimally invasive approach in patients with receding hairline. With this technique, visible scars were minimized, whereas still being able to achieve reasonable brow elevation. Thus, our approach enables long term maintenance of brow elevation with inconspicuous scars in the forehead.

The modified mini direct bone-anchored browlift for frontal paralysis

A myriad of techniques have been described to correct brow ptosis via a blepharoplasty incision, mid-forehead incision, endoscopic approach, pretrichial incision, coronal approach or direct brow lift. There are varying risks and results for each technique including paresthesia, facial nerve injury, alopecia, and unsightly scars. In this article we describe the mini-direct browlift technique that utilizes bone anchored sutures and allows for good cosmesis and control of brow height with minimal morbidity. A myriad of techniques have been described to correct brow ptosis via a blepharoplasty incision, mid-forehead incision, endoscopic approach, pretrichial incision, coronal approach or direct brow lift. There are varying risks and results for each technique including paresthesia, facial nerve injury, alopecia, and unsightly scars. In this article we describe the mini-direct browlift technique that utilizes bone anchored sutures and allows for good cosmesis and control of brow height with minimal morbidity.

Nuances of the Direct Brow Lift: Oculoplastic Surgeons’ Perspective

The direct supraciliary brow lift is an effective procedure to treat brow ptosis, limited by risk of a cosmetically undesirable scar. We performed a comprehensive literature review of direct supraciliary brow lift techniques and provide a summary of the key considerations. The optimal direct brow lift is initiated with thoughtful incision design and a carefully beveled supraciliary incision. Subcutaneous tissue debulking and wound edge undermining optimize wound eversion and approximation. A layered meticulously executed skin closure is essential for optimal cosmesis. The senior author’s personal technique, incorporating these concepts, is described and illustrated. We reviewed 76 patients (141 brows) who underwent our refined technique. At the time of final follow-up visit (average 4.9 months), 72 patients (94.7%) reported complete satisfaction with results. Adverse outcomes were found in 4 patients (5.3%) and included transient paresthesias (n = 3) and hypertrophic scarring (n = 1). Postoperative care routinely included the use of topical steroids and additional treatment with microneedling and 5-fluorouracil in 2 patients (2.6%) to optimize healing. The direct supraciliary brow lift is a minimally invasive and effective procedure to correct brow ptosis and may yield excellent cosmesis when key principles are utilized.

Techniques of Eyebrow Lifting: A Narrative Review.

None of brow lift techniques are completely satisfactory because of their limited effectiveness, lack of longevity, and potential complications. The aim of this study was to provide a comprehensive review of the literature on the pros and cons of the most popular techniques in brow and forehead lift. Relevant original articles in the PubMed database (English language) were sought using the search terms “eyebrow lift", “forehead lift", "periorbital rejuvenation", "eyebrow ptosis", "blepharoplasty and eyebrow change", "surgical eyebrow lift", and "non-surgical eyebrow lift", No date limitation was considered. Titles and abstracts were scanned to include the most pertinent articles. Subsequently, full texts of included articles (111 articles) were skimmed and finally 56 references were selected for the review. A narrative synthesis of data was finally undertaken with particular attention to the indications, techniques, and common complications of the eyebrow lift procedures. Ten popular techniques including two non-surgical methods (Botulinum toxin A and soft tissue fillers) were reviewed in this article. In general, non-surgical methods of forehead/brow lift are temporary, need less experience and correction would be easier should any complication occur. Surgical methods are divided into three categories: trans-blepharoplasty eyebrow lift, direct eyebrow lift, and trans-forehead eyebrow/forehead lift. Currently, the most popular method is the endoscopic forehead lift approach even though its longevity is limited. Direct brow-lift is particularly useful in patients with facial palsy and those who are more likely to be accepting of the scar (male gender, high forehead hair line).

Endoscopic Temporal Brow Lift: Surgical Indications, Technique, and 10-Year Outcome Analysis.

Brow-lift techniques have evolved from the most invasive approach, such as a coronal brow lift, to a minimally invasive technique, such as an endoscopic brow lift over the past century. Although an endoscopic brow lift offers the advantage of being minimally invasive, it suffers from a high recurrence rate. The authors present their experience of combining an endoscopic and temporal brow lift approach for long-lasting results, and discuss the surgical indication, techniques, and outcome of an endoscopic temporal brow lift. A retrospective review was performed of patients who underwent brow rejuvenation from 2008 to 2018. Demographic, surgical procedure, complication, and outcome data were collected. Of the 159 patients who underwent a brow lift from 2008 to 2018, the mean patient age was 59.1 years, and 96 percent were women. Of the 159 patients, 71 underwent endoscopic temporal brow lift; their average age was 56.6 years, with an average body mass index of 22.9 kg/m, and 99 percent were women. The average brow elevation was 1.8 ± 1.7 mm at the midpupil, 1.9 ± 1.8 mm at the medial canthus, and 1.8 ± 1.7 mm at the lateral canthus. There was no difference in the amount of brow elevation at the three locations (p = 0.48). The complication rate for endoscopic temporal brow lift was 1.4 percent, with a mean postoperative follow-up of 231.7 days; one relapse required a repeated procedure. The authors' study reveals that an endoscopic temporal brow lift can elevate the medial and lateral brow effectively, with a low complication rate of 1.4 percent. This technique is an evolution from the more aggressive coronal brow lift and combines the strength of endoscopic and temporal techniques with less invasive incisions. The authors recommend this technique for patients with mild to moderate brow ptosis. Therapeutic, IV.

Simplified Lateral Brow Lift under Local Anesthesia for Correction of Lateral Hooding.

A limited incision lateral brow lift has been described as an alternative to the endoscopic or the bicoronal approaches. The senior author has developed a safe and effective lateral brow lift technique that can be performed in an office setting under local anesthesia. We retrospectively reviewed 150 consecutive patients who underwent a brow lift by the senior author (TAM). The technique begins with an upper blepharoplasty incision which is used to divide the corrugator under direct vision, followed by a release of the periorbital retaining ligaments. The lateral temporal incision is the access point for dissection above the deep temporal fascia then connecting to the subperiosteal plane, allowing full mobility of the brow. Galea is advanced with sutures and redundant skin is excised. All patients treated with this technique had resolution of lateral brow hooding. Two temporary neuropraxias of the frontal branch of the facial nerve were observed with full resolution and no permanent nerve injuries occurred. The revision rate was 7% and there was a 3% incidence of delayed wound healing at the temporal incision with no infections. One hundred forty-two patients (97%) underwent this procedure with sedation, 52 of which (35%) were in the office with light oral sedation. The limited incision lateral brow lift as described allows for safe elevation of the lateral brow. When complemented by upper blepharoplasty, this technique provides excellent and natural-appearing rejuvenation of the upper face.

Direct Brow Lift - An Update of Current Literature

Eyebrow ptosis is the earliest manifestation of the aging forehead. Surgical procedures to lift the ptotic brow were first published in the early 1900s and since the introduction of the direct brow lift technique, there have been numerous minor refinements to this procedure, as well as some major developments in surgical techniques. It was modified to utilize a mid-forehead or a coronal incision, and then superseded by the endoscopic technique of brow lifting. Yet, with the armory of brow lifting techniques that currently exist, there still is a major role for the direct brow lift, herein described in detail.

Endoscopic Brow Lift Fixation With Mitek Suture Anchors: A 9-Year Experience of a New "Ideal" Technique.

In recent years, the endoscopic technique has emerged as a minimally invasive approach to forehead rejuvenation, although the specific need for and mode of brow fixation for endoscopic brow lifts remain under considerable debate. An ideal fixation device should provide non-palpable long-lasting fixation and allow retention of the device post-operatively without the need for removal. It should also allow precise intraoperative adjustment for symmetry and correction of brow ptosis. The authors describe an endoscopic brow lift technique using an absorbable bone anchor, Mitek Microfix. A retrospective chart review was conducted in patients who underwent endoscopic brow lift procedures utilizing this fixation method at an academic practice. Outcomes evaluated included operative times, reoperation rates, palpability, fixation device permanence, incremental costs comparisons to conventional methods, efficacy, and technical learning curve. Complication rates were evaluated and the economic, incremental cost analysis of current fixation methods was reviewed. Eighty-two patients underwent single-procedure endoscopic brow fixation using the Mitek anchor over a 9-year period (2005-2014). The mean operative time was 100 minutes. There were no cases of implant palpability, alopecia, or other postoperative complications. Two patients underwent revision secondary lifts after an average of 5.5 months for temporal ptosis. The Mitek Microfix QuickAnchor provides durable, long-lasting fixation without device palpability. Its technical ease of use is demonstrated by the reasonable mean operative time achieved with the active involvement of resident surgeons. This device is operator-friendly, easy to use, fully indwelling, and provides lasting fixation without the development of palpability or alopecia.

Complications in Brow Lifts: A Systemic Review of Surgical and Nonsurgical Brow Rejuvenations.

Background:Brow lift has been a part of plastic surgeons’ armamentarium for over a century. Although there are multiple different techniques available, there has been a dearth of literature comparing which technique is better and has lesser complications. In this study, we performed a systemic literature review of all brow lift techniques to determine and compare complication rates of each technique.Methods:We performed a computerized search of brow rejuvenation techniques using the MEDLINE database. Data regarding the type of brow lift procedure, number of patients, and complications were collected.Results:The systematic review was performed in December of 2017. A total of 326 articles were identified initially, and 76 studies remained after final review. The review showed highest revision rate in the hairline brow lift (7.4%), highest numbness rate in the direct brow lift (5.5%), highest asymmetry rate in the temporal/lateral brow lift (1.5%), and highest alopecia rate in the endoscopic brow lift (2.8%). In addition, we found 5 studies in nonsurgical brow rejuvenation (3 botulinum toxin, 1 fat injection, 1 radiofrequency).Conclusion:Our study shows that each brow technique has a different complication profile, and it is important for plastic surgeons to understand the difference. Furthermore, the study demonstrated the lack of randomized prospective outcome studies and standardization of outcome measures in brow rejuvenation. We believe this information would be the key and next frontier in providing technically safe and long-lasting aesthetic outcomes for the patients.

What Neurotoxins Have Taught Us About the Brow: The Reintroduction and Review of the Transpalpebral Browpexy.

The use of neuromodulators has grown substantially in our society, particularly in the temporary treatment of brow ptosis. This study revisits the use of the transpalpebral browpexy for upper face and brow rejuvenation in the context of what has been learned from neuromodulators. A retrospective review of 97 subjects was conducted who had transpalpebral browpexy performed for lateral brow ptosis. Qualitative degree of brow elevation after the procedure was determined by examining before and after photographs for each patient. Out of 97 patients, 95 (98%) experienced aesthetically optimal brow elevation for their respective gender. Two patients required surgical revision, both of which experienced extenuating circumstances. Two patients experienced edema and one patient experienced periodic eruptions of chalazia along the upper eyelid. Transpalpebral browpexy is a reliable, minimally invasive surgical procedure that effectively emulates the results of neuromodulator injections for a much longer period of time. While it cannot replace traditional brow-lifting techniques, transpalpebral browpexy does have solid indications with proven long-lasting results, which can be effective in a significant portion of patients with brow ptosis. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Lateral Browlift Using Temporal (Pretrichial) Subcutaneous Approach Under Local Anesthesia

Lateral brow ptosis is a common aging phenomenon, contributing to the lateral upper eyelid hooding, in addition to dermatochalasis. Lateral brow lift complements upper blepharoplasty in achieving a youthful periorbital appearance. In this study, the author reports his experience in utilizing a temporal (pretrichial) subcutaneous lateral brow lift technique under local anesthesia. A retrospective analysis of all patients undergoing the proposed technique by one surgeon from 2009 to 2016 was conducted. Additional procedures were recorded. Preoperative and postoperative photographs at the longest follow-up visit were used for analysis. Operation was performed under local anesthesia. The surgical technique included a temporal (pretrichial) incision with subcutaneous dissection toward the lateral brow, with superolateral lift and closure. Total of 45 patients (44 females, 1 male; mean age: 58 years) underwent the temporal (pretrichial) subcutaneous lateral brow lift technique under local anesthesia in office setting. The procedure was unilateral in 4 cases. Additional procedures included upper blepharoplasty (38), ptosis surgery (16), and lower blepharoplasty (24). Average follow-up time was 1 year (range, 6 months to 5 years). All patients were satisfied with the eyebrow contour and scar appearance. One patient required additional brow lift on one side for asymmetry. There were no cases of frontal nerve paralysis. In conclusion, the temporal (pretrichial) subcutaneous approach is an effective, safe technique for lateral brow lift/contouring, which can be performed under local anesthesia. It is ideal for women. Additional advantages include ease of operation, cost, and shortening the hairline (if necessary).