Introduction

A brow lift procedure is performed with the aim of restoring the firmness in the upper third of the face which consequently can make a person look youthful. The upper third can be imagined to begin from the top of the eyebrows extending to anterior hairline. The loss of collagen that happens with age can lead to brow ptosis which generally causes obstructed vision and a saggy appearance. The change in appearance is also caused by gravity and unprotected exposure to the rays of sun. Forehead wrinkles are also often accompanied with this loss of youthful skin of the face. The droopiness of the eyebrows in combination with deep grooves of the forehead can give a very tired look to a person. Fortunately, many modern cosmetic procedures are available that can help in achieving a brow lift to make a person look younger. The various techniques that are available are classified according to the approach of surgery they utilize. They are also descriptive about the type of incisions that are employed to achieve the final result.

Types of brow lift techniques available:-

Depending upon the approach that is used brow lift procedures can be broadly classified into two categories namely open brow lift and endoscopic brow lift.

Open brow lift techniques can be further classified as; direct brow lift, indirect brow lift and pretrichial brow lift procedure.

Pretrichial brow lift:-

In pretrichial brow lift the incision is made in front of the hairline. For better cosmetic results, generally the incision is made slightly behind the hairline. This helps in hair growth through the scar so that it is concealed in a better way. For the treatment, the surgeon first observes the normal position of the eyebrows, eyelids and the hairline. The surgeon then manually lifts the eyebrows to understand the condition of the eyelids in conjunction of the eyebrows. The surgeon will make a realistic assessment of the situation and then tell the patient about what results to expect from the surgery. The general rule of thumb is that the pretrichial incision is made in the patients who have a wide forehead. In males who have a receding hairline or family history of male pattern baldness, provision for additional allowance is made. A partial pretrichial brow lift can be done in the cases where the droopiness is only on one eyebrow. Also, pretrichial brow lift does not elevate the hairline at all. This can be quite advantageous in the cases where the patient already has a receding hairline. These two reasons can be considered to be clear advantages of pretrichial brow lift over other techniques. The disadvantage of pretrichial brow lift is that scar may be quite visible in some cases. This is where an endoscopic brow lift has a clear advantage over all other surgical approaches as in an endoscopic brow lift very minimal incisions are made which lead to nearly invisible scars. Forehead numbness may be present after the surgery, however, pretrichial brow lift technique is considered to be the best technique for addressing the asymmetry of the eyebrows and also for achieving lateral brow lift. Pretrichial brow lift has a clear advantage in female patients who can cover the residual scar with different hairstyles whereas in males the scar can pose a problem.

Some facts about pretrichial brow lift procedures:-

Generally all cosmetic procedures are done because of a personal desire of the patient and as such there may not be a medical need for the surgery. Therefore before performing a pretrichial brow lift or any other cosmetic surgical procedure the surgeon will make a physical as well as psychological assessment of the patient to determine if the patient is fit to undergo the surgery. The patient will be asked a series of questions by the cosmetic surgeon, which may include questions about the expectations from the outcome of the surgery and the reason for undergoing the cosmetic procedure. Emotional instability may cause a surgeon to discourage the patient from getting the surgery. If the patient is considered suitable for the surgery, the surgeon will go ahead and make the physical assessment of the patient by lifting the skin around the eyebrows and the forehead. The surgeon will then ask the patient to move various muscles of the face to observe the activity of the facial muscles of the patient. Sometimes, after diagnosis the cosmetic surgeon may suggest an additional procedure like blepharoplasty which would improve the cosmetic result of the surgery. The final decision about the approach and additional procedures will be made by the surgeon depending upon the features of the patient, the hairline, the expected outcome and the current position of the eyebrows.

Minor complications after a pretrichial brow lift are the same as other ophthalmic procedures which may include bleeding, numbness and infection.


About Dr. Debraj Shome

Debraj Shome-2
Debraj Shome, MD, DO, DNB, FRCS (Glasgow), FICO (USA), MNAMS, MBA (Healthcare Management, Vanderbilt University, USA), is Consultant Facial Plastic Surgeon, Oculoplastic Surgeon & Cosmetic Surgeon at Nova Specialty Surgery, Mumbai, India..Read more

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