Background:

Various techniques have been described for elevation of the ptotic brow. A subcutaneous, temporal approach is a simple and effective procedure for elevation of the central and lateral brow particularly in patients with an elevated frontal hairline or in cases of positional brow asymmetry. We describe our technique and experience with this procedure using local anesthesia in the office setting.

Methods and Materials:

A retrospective assessment was conducted of patients treated with this approach from the years 2000-2006. All procedures were performed in our minor procedure room using only local anesthesia. The proposed surgical approach consists of a temporal incision located at the frontal hairline and extending into the temporal hair bearing scalp. A subcutaneous elevation of the forehead skin was performed to the level of the brow. A slightly greater than 2:1 excision of skin was performed along a superior/lateral vector depending on the patient's preferences. A single layer closure was then performed and a dressing placed for 48 hours. Preoperative and postoperative photographs were evaluated for the effectiveness of the procedure.

Results:

A total of 28 patients were treated over this 7 year period with 23 bilateral and 5 unilateral procedures performed. All patients healed without complication and only one patient required revision surgery to remove a small dog ear. An additional patient desired a greater degree of lift and was subsequently revised. Scarring was minimal and was rated as excellent by both patients and surgeon. The effectiveness of the brow elevation was rated as good to excellent in all but one patient. Facility costs associated with this procedure averaged $400.

Conclusions:

Brow lift is often an essential facet for a pleasing aesthetic result in the periorbital region. This subcutaneous brow lift technique adds to the armamentarium of techniques that are available, and can be performed in the office under local anesthesia. It has proven to be a very effective, reproducible and inexpensive technique. In addition, it can be an excellent stand alone procedure in younger patients and be revised easily without the need for general anesthesia.

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