Abstract

Objectives: To discuss normal brow aesthetics To present a simple means of diagnosis and treatment To demonstrate combinations of fat grafting and lifting Introduction: Browlifting is both an under utilized and over utilized procedure. The objective is not to demonstrate surgical bravado and show amazing lifting effects, but rather to aesthetically enhance and reverse signs of the aging brow and periorbita. Materials / method: All patients undergo an aesthetic evaluation that includes assessing the degree of photo damage, volume loss, laxity and degree of orbital bone expansion and recession. Recommendations for brow lifting are made based on the position of the eyebrow relative to the supraorbital rim and on the degree of eyelid and brow laxity lateral to the lateral canthus. When indicated a modified subcutaneous gliding brow lift or marionette lift is performed. In patients desiring midface and malar elevation, endoscopic brow lift is recommended with a sub-periosteal, supra-periosteal and sub-SMAS dissection. Results: Results have been very satisfactory in 90% of patients. In some, mild relapse has occurred, with one patient in the past 5 years requesting revision. Fat grafting results have been best in patients under 55 years of age. Long term outcomes have been documented up to 10 years. Conclusion: A 3 dimensional approach to brow lifting is recommended based on the anatomical findings. Best outcomes are seen when sun damage, volume loss and laxity as well as pre-existing skeletal deficiencies are simultaneously addressed. Over correction of brows lead to suboptimal results.