Abstract

Objectives: To discuss brow aging, the main physical findings and to present several simple approaches to restoring volume and brow position. Introduction: Brow aging is more than a 2D change like a curtain dropping. Rather, it is a subtle and complex change in volume and brow position. Materials / method: To address the brow in a 3D fashion, fat grafting of the temporal region, deep and superficially, the tail of the brow and the inferior aspect of the superior orbital rim are structurally grafted with microfat (1 mm parcel size). Following fat grafting at the same procedure, a simple subcutaneous brow lift is performed for the majority of patients. More extensive subperiosteal and deep plane treatments of the midface may be needed in selected patients. Results: Our best outcomes have been from fat grafting combined with a modified subcutaneous browlift using direct suture fixation to the subcutaneous brow at one or more points through 2-3 small incisions within or at the hairline. A modified GBL can be added in cases of bleeding or for additional fixation of the lateral brow. Conclusion: Many approaches to the brow have been used by the author. Currently, I favor the subcutaneous brow lift with placement of a subcutaneous 3.0 or 4.0 PDS suture under the lateral brow. Virtually, all cases are combined with structural fat grafting.