Aesthet Surg J 2017 03 16. Epub 2017 Mar 16.

Dr Angelini is a plastic surgeon in private practice in Rome, Italy.

Background: The height of the eyebrow is less crucial aesthetically than is the relationship between the lateral and medial portions of the brow. Although various surgical procedures are effective in raising the brow, the authors maintain that transcutaneous brow shaping (TBS) is the only technique that enables precise shaping of the brow and correction of minor asymmetries.

Objectives: The authors described their experiences with direct TBS alone or in conjunction with blepharoplasty and facelift. Read More

Lasers Surg Med 2016 Oct 9;48(8):742-747. Epub 2016 Aug 9.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida 33136.

Purpose: To investigate 1,064 nm long-pulse Nd:YAG laser for postoperative treatment of direct browplasty scars.

Methods: Nine patients who underwent direct browplasty were enrolled in this prospective study. Subjects were randomized to unilateral laser treatment at 2-week intervals for six total treatments, with the contralateral scar used as a control. Read More

J Craniomaxillofac Surg 2016 Aug 24;44(8):958-63. Epub 2016 May 24.

Department of Cranio-Maxillofacial Plastic Surgery, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany; Adult Aesthetic and Reconstructive Surgery of the Face at Aneasthesia Center Hamburg at UKE, Hamburg, Germany; Pediatric Facial Plastic Surgery and Craniofacial Anomalies at the Catholic Children's Hospital Wilhelmstift, Hamburg, Germany. Electronic address:

Background: A huge number of procedures for forehead and brow rejuvenation have been described. Nevertheless, the surgical approach of brow aesthetics in terms of correction of brow fullness and symmetry has not been systematically evaluated in the literature. We recently proposed a 20-degree beveled brow incision technique for direct brow lifting. Read More

Indian J Plast Surg 2016 Jan-Apr;49(1):66-71

Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, Rome, Italy.

Context: Brow lifting is an essential element in the rejuvenation of the ageing face. Various surgical techniques have been described. Among these, the direct brow lifting is an easy and effective technique that is often neglected because the scar can remain visible. Read More

Aesthetic Plast Surg 2016 Jun 22;40(3):343-8. Epub 2016 Mar 22.

Institute of Plastic Surgery, Xijing Hospital, FMMU, Changle West Road 127#, Xi'an, 710032, Shaanxi, China.

Background: Direct brow lift surgery remains popular among Asian women despite its disadvantages. The traditional direct brow lift by a supra-brow incision is not suitable for Asian women because of their unique facial features, such as higher eyebrows, wider upper eyelids, and more orbital fat. Therefore, we designed a novel brow lift technique via a supra-brow combined with an infra-brow approach for Asian women. Read More

J Craniofac Surg 2016 Mar;27(2):365-9

*Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, Rome†Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.

Objectives: The current article is aimed to test the effectiveness of direct and indirect brow lifting to correct brows asymmetry.

Methods: Fifty patients treated with direct brow lift between January of 2011 and January of 2013 were investigated. All patients were men and treated under local anesthesia. Read More

J Dtsch Dermatol Ges 2015 Dec;13(12):1298-301

Department of Dermatology, Venereology, and Allergology, University Medical Center Leipzig, Leipzig, Germany.

Ned Tijdschr Tandheelkd 2014 Oct;121(10):507-15

A prominent characteristic of the aging face is the descent of skin and subcutaneous tissues. In order to reduce this and create a more youthful appearance, several lifting procedures can be employed. In the forehead and eyebrow region the transblepharoplastic brow lift, the direct brow lift, the temporal brow lift, the coronal brow lift and the endoscopic brow lift can be distinguished. Read More

Ann Otol Rhinol Laryngol 2015 Apr 4;124(4):273-9. Epub 2014 Dec 4.

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

Objectives: Paralytic lagophthalmos can lead to devastating exposure keratitis. The main surgical intervention consists of upper eyelid loading. However, adjunctive lower eyelid and brow procedures are also available as necessary. Read More

Ophthal Plast Reconstr Surg 2015 May-Jun;31(3):182-6

*Department of Ophthalmology, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; †Division of Ophthalmology, Section Oculofacial Plastic and Reconstructive Surgery, Ohio University/Doctor's Hospital, Columbus, Ohio; ‡Department of Ophthalmology, Oral and Maxillofacial Surgery, Grant Medical Center, Columbus, Ohio; and §Department of Ophthalmology, Loyola University Health System, Maywood, Illinois, U.S.A.

Purpose: To assess intraoperative blood splatter to the ocular surface and adnexa during oculofacial surgery.

Methods: Four surgeons and multiple assistants at three separate locations wore a total of 331 protective eye shields during 131 surgeries. Postoperatively, a luminol blood detection system was used to identify blood splatter on the shields. Read More

Can J Plast Surg 2013 ;21(3):173-7

Division of Plastic Surgery, Department of Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario.

Background: Ideal eyebrow aesthetics give a framework for brow rejuvenation and surgical procedures do not always provide satisfying results. Previous studies have shown elevation of the medial brow with aging; however, they failed to characterize overall shape changes.

Objective: To characterize changes in eyebrow slope with increasing age to better direct brow rejuvenation. Read More

Arch Plast Surg 2013 Sep 13;40(5):603-9. Epub 2013 Sep 13.

Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Korea.

Background: Although the conventional direct brow lift operation provides a simple means of managing lateral brow ptosis, the scars produced have been unacceptable. However, using the modifications proposed here, scarring showed remarkable improvement. This article reviews our experiences with the presented technique, mainly with respect to postoperative scarring. Read More

Dermatol Surg 2013 Jul 13;39(7):1132-4. Epub 2013 May 13.

Ophthal Plast Reconstr Surg 2013 Jan-Feb;29(1):67-70

Moorfields Eye Hospital, London, United Kingdom.

Purpose: Forehead paresthesia after brow lift is well-documented with rates as high as 40.7%. The authors describe an anatomical study to identify the variation in position of the supraorbital notch/foramen to define safe limits for deep dissection during this procedure. Read More

Clin Plast Surg 2013 Jan 26;40(1):117-24. Epub 2012 Aug 26.

Paces Plastic Surgery, Atlanta, GA 30327, USA.

The open brow lift procedure is discussed in terms of relevant surgical anatomy, preoperative evaluation, and detailed surgical technique for pretrichial coronal forehead lift with hair-bearing temporal lift, direct incisional brow lift, and coronal brow lift. Complications are discussed, and information is presented on patient evaluation and expectations, with a discussion of what patients can expect before and after brow lift surgery. Read More

Clin Plast Surg 2013 Jan 27;40(1):105-15. Epub 2012 Aug 27.

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR 97239, USA.

The authors discuss how, in performing an endoscopic brow lift, meticulous surgical technique, adherence to anatomic dissection planes, and direct visualization used at key points in the procedure enable a safer, more-complete dissection and a better outcome. Anatomy as it relates to the procedure is discussed. Patient evaluation and patient expectations are reviewed with a discussion of the points to present to patients about outcomes of this surgery. Read More

Aesthetic Plast Surg 2012 Oct 31;36(5):1047-51. Epub 2012 Aug 31.

Division of Plastic Surgery, Universidade Federal de São Paulo, Rua Napoleão de Barros, São Paulo, Brazil.

Background: The orbital region is of vital importance to facial expression. Brow ptosis, besides having an impact on facial harmony, is a sign of aging. Various surgical techniques have been developed to increase the efficacy of brow-lift surgery. Read More

J Cutan Aesthet Surg 2011 Sep;4(3):201-4

Department of Dermatology and Allergology, Hospital Dresden-Friedrichstadt, Academic Teaching Hospital of the Technical University of Dresden, Friedrichstrasse 41, Dresden, Germany.

Radical surgery of fronto-temporal non-melanoma skin cancer (NMSC) sometimes causes palsy of the frontal facialis branch. Patients may experience visual impairment due to brow and upper eyelid ptosis. Since NMSC predominantly affects elderly people, the corrective surgical procedures have to be adapted to age, comorbidities and individual needs. Read More

Plast Reconstr Surg 2011 Oct;128(4):335e-341e

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-9163, USA.

Background: Currently, there are many well-described surgical approaches to address brow aesthetics (i.e., open versus endoscopic versus combination techniques). Read More

Aesthetic Plast Surg 2012 Apr;36(2):468-71

Plast Reconstr Surg 2012 Feb;129(2):275e-287e

The Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.

Background: Radical parotidectomy presents a unique combination of reconstructive challenges. The high visibility of the region and the specialized structures involved create an interdependence between aesthetics and function. This article describes the authors' surgical concepts and experience in post-radical parotidectomy reconstruction. Read More

Facial Plast Surg 2011 Feb 18;27(1):50-7. Epub 2011 Jan 18.

Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon 29239, USA.

Forehead lifting serves to restore a more youthful appearance as well as a more functional and aesthetically pleasing brow position. The purpose of this review is to describe the pertinent anatomy and forehead aesthetics, then to discuss the patient evaluation, surgical approaches, complications, and nonsurgical adjuncts. Anatomic features reviewed include the layers of the forehead and scalp, blood supply, innervation, musculature, and the temporal branch of the facial nerve anatomy. Read More

Aesthet Surg J 2010 Nov-Dec;30(6):802-9

Department of Otolaryngology-Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.

Background: Brow droop, eyelid tissue excess, and hyperfunction of the muscles of forehead facial expression may contribute to the aging diathesis of the upper one-third of the face. Many approaches to the brow have been described, including coronal or pretricheal incisions, direct incision of the suprabrow or forehead, and endoscopic techniques. A less frequent technique, the transblepharoplasty browlift (TBBL), has a role in rejuvenating brow position, especially in patients in whom both the eyelids and brows need to be addressed. Read More

Facial Plast Surg 2010 Aug 3;26(3):186-92. Epub 2010 Jun 3.

Center for Facial Appearances, Salt Lake City, Utah, USA.

This study evaluates the effectiveness of five surgical techniques for brow ptosis repair including internal brow release (IBR), internal brow release with brow pexy (IBR + BP), internal brow release with corrugator and depressor supercilii removal (IBR + CDR), direct brow-lift (DB), and endoscopic brow-lift (EB). This is a retrospective study of 120 patients in which the preoperative and postoperative position of the medial, central, and lateral brow on both sides was measured. The brow was elevated 1. Read More

Orbit 2009 ;28(6):347-53

National University Health System, Singapore.

Background: To describe the indications, techniques and outcomes of various browlift procedures in a predominantly East-Asian community.

Patients And Methods: Retrospective review of patients who underwent browlift procedures performed by 2 oculoplastic surgeons or under their direct supervision, in a tertiary referral hospital in South East Asia from 2002 to 2007.

Results: Forty-six patients (30 female, 16 male) had browlift surgery for 89 sides from 2002 to 2007. Read More

Indian J Plast Surg 2009 Jan-Jun;42(1):58-62

Member of International College of Surgeons, Brazil.

One of the first signs of facial ageing appears in the forehead, with the descent of the lateral part of the brow. This is a troubling condition for all patients and elevation of the lateral part of the brow becomes a more and more frequent demand. The authors present their experience in 350 consecutive cases of direct eyebrow lift ("butterfly wing" incision) alone or in combination with rhytidectomy and/or blepharoplasty. Read More

Aesthet Surg J 2008 Sep-Oct;28(5):512-7

Carmel Medical Center, Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.

Background: Eyebrow ptosis and hooding gives the eye a sad, heavy look that often disturbs the visual field.

Objective: A direct extended scalpel-shaped brow lift is proposed to correct this functional and aesthetic disfigurement. This manuscript reviews our experience with the presented technique and evaluates the clinical results in the light of ongoing concerns regarding the appearance of the postoperative scar. Read More

Dermatol Surg 2008 Oct 3;34(10):1350-61; discussion 1362. Epub 2008 Jul 3.

Group Private Practice, Oral & Maxillofacial Surgery, Richmond, Virginia 23235, USA.

Purpose: The purpose is to present a less invasive and technically simpler method for brow and forehead rejuvenation and literature review on the subject.

Materials And Methods: Fifty consecutive female patients were treated with the subcutaneous brow-lift technique over a 30-month period by the same surgeon. This surgical technique is performed under direct vision utilizing an extreme beveled incision made 4 to 5 mm into the anterior hairline with subcutaneous dissection of the anterior forehead only with the excision of 1. Read More

Clin Plast Surg 2008 Jul;35(3):381-92; discussion 379

Department of Plastic and Reconstructive Surgery, Pontifical Catholic University of Rio de Janeiro, Brazil.

The combined-access brow lift described in this article is a limited-incision technique that can provide a cosmetic effect comparable to that produced by the coronal incision technique. It also allows safe direct visualization of anatomic structures comparable to that allowed by the endoscopic-assisted technique, but because it requires no endoscopic instrumentation, it is less expensive and takes less time to learn. Read More

Ann Plast Surg 2008 Jan;60(1):2-5

Langsdon Clinic, Germantown, TN, USA.

Brow position and hyperfunction of the muscles of forehead facial expression contribute to the aging diathesis of the upper one third of the face. In many cases, the eyelids and brows are addressed together to achieve a satisfying rejuvenation effect. Many different approaches to the brow are used, including the long coronal or pretricheal incisions, direct incision of the suprabrow or forehead, and finally the use of smaller incisions with an endoscopic technique. Read More

Semin Plast Surg 2008 Feb;22(1):43-9

Associate Professor of Plastic Surgery, Athens, Greece.

Endoscopic brow lift has become widely accepted as a procedure for restoring a youthful brow, as only three, hardly noticeable incisions of the scalp are needed for this subperiosteal dissection and final repositioning of the brow. It has become an acceptable technique, an alternative to the conventional technique or transcoronal browpexy. Endoscopic brow lift allows separation and repositioning of the periosteum of the orbital rims and zygomaxilla. Read More

Ophthal Plast Reconstr Surg 2007 Sep-Oct;23(5):372-5

Corneo Plastic Unit, Queen Victoria Hospital, East Grinstead, Sussex, United Kingdom.

Purpose: To describe a technique of endoscopic harvesting of autogenous fascia lata.

Methods: A retrospective, noncomparative clinical study to evaluate the technique of videoendoscope assistance in harvesting autogenous fascia lata was conducted during a 1-year period in 2002. A small incision approximately 2 cm long is made over the lateral aspect of the thigh, either as a low or high approach. Read More

Aesthet Surg J 2007 Jul-Aug;27(4):388-95

Presbyterian Hospital of Allen, TX, USA.

Background: Current aesthetic literature reflects a renewed interest in the subcutaneous brow lift. The authors believe that this trend is based on the principle that the most direct approach to elevating the brows is subcutaneous dissection with skin advancement. Furthermore, the addition of progressive tension sutures (PTSs) to the subcutaneous brow lift permits precise fixation of brow position, controlled advancement of the forehead flap, and elimination of dead space. Read More

Facial Plast Surg 2007 Feb;23(1):27-42; discussion 43-4

Department of Otolaryngology, University of Southern California School of Medicine, Los Angeles, CA, USA.

As we become more confident with our surgical skills following our fellowship training, some of our approaches and techniques will be modified or changed. My primary evolutionary change involves procedures of the upper third of the face, primarily the brow lift and treatment of lower eyelid fat techniques. Traditional methods of forehead and brow rejuvenation, such as coronal, pretrichal, and direct brow lifts, have provided facial plastic surgeons with effective brow elevation for many years. Read More

Orbit 2006 Dec;25(4):261-5

Department of Ophthalmology, Salisbury Health Care, Salisbury, Wiltshire, UK.

Brow ptosis occurs as part of the aging process, and as a complication of facial nerve paresis. The article addresses the options available for correction of brow ptosis. The direct brow lift is effective for medial and central brow ptosis, and additional lift laterally may occasionally be needed. Read More

Arch Facial Plast Surg 2005 Jan-Feb;7(1):51-4

Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA.

Traditionally, the asymmetrical brow in facial paralysis has been treated with open procedures. There are few data that support the use of endoscopic procedures to treat patients with facial palsy or paralysis. We sought to evaluate a single surgeon's experience with the use of endoscopic forehead-lifts to treat asymmetrical brow positioning resulting from facial nerve disorders. Read More

Br J Ophthalmol 2004 May;88(5):688-91

Salisbury District Hospital, Salisbury SP2 8BJ, Wilts, UK.

Background/aims: The direct brow lift operation can be used to treat brow ptosis arising from either involutional changes or facial nerve palsy. The authors reviewed their experience with this operation to establish its efficacy and complication rate in the light of concerns over poor scar cosmesis and forehead paraesthesiae in the postoperative period.

Methods: A retrospective review of patients undergoing direct brow lifting from 1989 to 2002 was conducted, and information gained on patient satisfaction by questionnaire. Read More

Atlas Oral Maxillofac Surg Clin North Am 2003 Sep;11(2):145-55

Willow Bend Cosmetic Surgery Center, 5824 W. Plano Parkway, Suite 101, Plano, TX 75093, USA.

Improvements in technology have increased the level of patient care in all aspects of medicine and surgery. This is no less true in the area of cosmetic surgery. The use of endoscopy has led to improved aesthetics with respect to postoperative scarring, decreased healing time for patients, and an increase in overall patient satisfaction. Read More

Facial Plast Surg 2000 ;16(3):283-98

Johns Hopkins University, and University of Maryland, Schools of Medicine, Baltimore, MD, USA.

The central oval of the face is a distinct anatomic and aesthetic unit. Early signs of aging and advanced features of aging are manifested primarily in this unit. Standard face lift techniques are ineffective in treating this area. Read More

Plast Reconstr Surg 2000 Mar;105(3):1120-7; discussion 1128

Division of Plastic and Reconstructive Surgery, UCLA Medical Center, Los Angeles, Calif, 90095-6960, USA.

The authors report consistent improvement in 65 patients with lateral brow ptosis by using a lateral subcutaneous brow lift at the temporal hairline. In 48 of these patients, vertical glabellar wrinkles were improved by the direct excision of procerus, corrugator, and orbicularis muscles through 3-mm medial brow incisions. Anatomic dissections in 10 cadavers and examinations of 50 skulls were used to study the location of the supraorbital and supratrochlear nerves. Read More

Aesthetic Plast Surg 1998 Sep-Oct;22(5):338-40

La Jolla, California, USA.

Endoscopic brow lift has now become a well-established procedure for restoring a youthful brow. Multiple techniques have been described for fixation of the scalp; however, these methods do not allow for direct positioning of the brow. A simple method is described that establishes precise and direct brow fixation using K-wires. Read More

Plast Reconstr Surg 1998 Apr;101(4):1075-84

Medical University of South Carolina and the Spartanburg Regional Medical Center, USA.

Coronal foreheadplasty has long been the traditional method of improving the aesthetic appearance of the forehead, permitting not only repositioning of ptotic tissues but also direct access for modification of the "frown" muscles. However, it was only moderately successful in eliminating vertical corrugator lines or deeply etched transverse wrinkles. The recent advent of the endoscopic brow lift has permitted us to minimize the dysesthesias associated with the coronal approach by making the incisions shorter and radially oriented and by being more precise in the muscle resection. Read More

Klin Monbl Augenheilkd 1997 Jul;211(1):37-40

Abteilung A, Universitäts Augenklinik Wien.

Background: The Frontalis Suspension Technique is indicated in cases with minimal or no levator function. At the beginning sutures were used as sling material and after further modifications suture material was replaced by autologous or homologous fascia lata. In the last years ePTFE has proved to be a very suitable sling material. Read More

Plast Reconstr Surg 1997 Jul;100(1):262-6

Department of Ophthalmology and Visual Sciences, University of Illinois, Chicago College of Medicine, USA.

Placement of screws at the posterior aspect of the incision sites and the gradual placement and removal of staples behind the screws allow for a controlled and titrated elevation of the forehead and brows. This technique does require the patient's acceptance of the temporary placement of screws and staples into the scalp, which in my experience has not been a problem. By seating the patient upright on the operating table, the surgeon can intraoperatively make a direct evaluation and adjustments (removal or addition of staples). Read More

Plast Reconstr Surg 1996 Apr;97(5):1040-50; discussion 1051-2

In brow lift, if a direct approach is utilized, the suture line medially is placed in a normal frontalis crease, and then the lateral part of the suture line, by lateral transfer of a small superiorly based flap, is caused to fall into a natural "laugh line" or "crow's feet" crease, three improvements result: 1. Greater control and predictability of shaping and position than with other techniques; 2. A more normal appearance, including better lateral lift and a much more inconspicuous scar than with supraciliary direct lift; 3. Read More

Aesthetic Plast Surg 1996 Mar-Apr;20(2):129-34

Newport Beach, California, USA.

Contemporary options for correction of the aging upper one-third of the face include open techniques with a coronal or anterior hairline incision, endoscopic access to the forehead including muscle transection, brow lift through direct forehead skin excision and various forms of brow-pexies. Realizing the common need for aesthetic improvement in the upper eyelids and desiring minimal incisions for forehead rejuvenation, an approach through the blepharoplasty incision has been developed which addresses all of the components of the aging upper third of the face: A combined subperiosteal approach for forehead elevation and transection of corrugator and procerus muscles through the blepharoplasty incision is presented. The postoperative improvements in the position of the brow as well as improvement in the glabellar area rivals other approaches and allows simultaneous improvement in upper eyelid aesthetics. Read More

Aesthetic Plast Surg 1991 ;15(2):141-7

We have developed clinically useful measurements to assist the surgeon in deciding when to do the forehead lift and where to place the incision. Also, we have reviewed our experience over the past decade and discuss the four categories and applications of forehead lifts. We use three indications for forehead lift: ptosis, creases, and previous facelift (PCP). Read More

Am J Otol 1985 Nov;Suppl:62-7

Three basic types of procedures are used by the author to reanimate the face paralyzed by interruption of the facial nerve at the skull base. In order of choice they are direct nerve repair or grafting; hypoglossal-facial nerve anastomosis; and regional facial reanimation (brow lift, implantation of a gold weight or spring in the eyelid, tightening of the lower eyelid, and temporalis muscle transposition to reanimate the mouth). The indications for and expected results of each approach are presented with special emphasis on the usefulness of regional reanimation. Read More

Am J Ophthalmol 1983 Dec;96(6):751-4

We use a coronal brow lift to correct brow ptosis and associated forehead wrinkling. This technique eliminates the disadvantages of the traditional direct brow elevation, including scarring above the brow and failure to correct forehead and glabellar ptosis and wrinkling. The entire upper face is elevated as a unit, preserving the natural anatomy as much as possible. Read More

Arch Otolaryngol 1983 Mar;109(3):155-9

Ptosis of the brow-glabellar tissues with or without vertical and horizontal wrinkling accompanies aging in other areas of the face. The direct browlift is effective in elevating and shaping brow tissues, but leaves a scar at the brow-forehead juncture and does little for glabellar deformity. The coronal forehead lift allows the correction of brow-glabellar ptosis and wrinkling with camouflage of the scar in the scalp. Read More