Can My Forehead Be Shortened At The Same Time As A Browlift?
Q: Dr. Eppley, I am interested in the combination of a browlift and a hairline advancement. My brows are now sagging too low and I have always had a high forehead. With a browlift alone I fear that the front part of my hairline will go back further with some of the browlift methods. I visited a plastic surgeon and he told me that both could not be done at the same time. But I have also read in your articles that it can be done simultaneously. I am confused. If they can be done at the same time, how does it work? And why would this plastic surgeon say it can’t be done?
A: Just like a browlift loosens and lifts the forehead tissues upward, the scalp can be loosened and moved forward. They key to these procedures is that when done independently, they rely on having a fixed point onto which the loosened tissues are fixed. For the browlift, it is the frontal hairline, For a frontal hairline advancement, it is the forehead tissues as the fixed point. When doing a hairline (pretrichial) browlift and frontal hairline advancement at the same time, which can easily and most conveniently be done together, the key is to create a point onto which both can be used for stabilization. There are different ways to achieve the fixation of the two flaps but I prefer to use outer cranial table drill holes with galeal suture fixation. This not only provides good fixation but keeps the tension off of the suture line so the hairline scar does not widen and excessively show. For the right patient, this combination can produce excellent results and achieve a more total forehead rejuvenation. I can understand why some plastic surgeons would not combine these two procedures as their movements seem to be working against each other. But that is a matter of preference and experience, not an issue of technical feasibility.
Dr. Barry Eppley