Can I Get A Browlift Reversal If I Have Had A Prior Scalp Advancement?

Q: Dr. Eppley, Many years ago I had an endoscopic brow lift that left my brows significantly higher than expected, leaving me with what is typically described as a startled, or ‘deer-in-the-headlights’, look. I’m researching as to whether my brows can be lowered and, if so, how much? I have read where, yes, brows can be lowered through reverse brow lift brow surgery, but my case is perhaps more difficult. 

Subsequently I underwent FFS (Facial Feminization Surgery). My FFS was somewhat extensive, leaving me to wonder now whether reverse brow lift surgery is even possible. 

Besides a brow lift I also had a scalp advancement to bring my hairline forward, rhinoplasty, and supraorbital rims were shaved to reduce brow protuberance. This left me with 2 post-surgical effects I find particularly bothersome: 

1. I cannot frown; that is, I have no ‘down’ muscle control. I can raise my brows, but I cannot lower them. 

2. I still have a fair degree of numbness in my upper forehead region, extending into my scalp to such an extent that the top of my head feels like I’m wearing a bike helmet. 

To both of these concerns I was told by my surgeon that they would self-resolve over a year or so. They did not. 

So I leave you with this question: do you believe I’m a candidate for reverse brow lift surgery? 

Thanks for your time.

A: Thank you for your inquiry and sending your pictures. Normally a reverse browlift is based on the concept of an epicranial shift…meaning the entire scalp is mobilized and brought forward rather than back as in an endoscopic brow lift. But having had a hairline advancement as well as a browlift (and having lost some forehead skin in the process) would suggest that this approach would not work. You need a more reliable solution to release the scarred tissues AND create more scalp tissue (or at least stretch it better) and that would be a scalp tissue expander. Placed on the back of the head and gradually inflated you would create enough tissue mobilization to get a reverser browlift effect as well as improve the tightness across the top of your head. This would, however, not change the lack of depressor forehead/brow function.

Dr. Barry Eppley

Indianapolis, Indiana