Is A Transpalpebral Approach A Good Browlift Method?

Q: Dr. Eppley, I am interested in getting a browlift and an upper blepharoplasty fro my hooded eyes and low brows. I am now 54 years old. Three years ago I had a facelift done and, although I am happy with the neck and jowl results, the scars around my ears have significantly widened. This has made me afraid of doing any type of browlift as I don’t want a wide scar in my scalp. I wear my hair with bangs and I also have a high forehead. What are your thoughts on the transpalpebral approach to browlift surgery?

A: While a transpalpebral browlift avoids any hairline scars, the ‘price’ to be paid for that decision is that it does a relatively poor job of lifting the brow. At best, it can only make a minor elevation of the tail of the eyebrow. It illustrates a basic principle that you can’t really lift much when all you are doing is pushing up from below. It can not elevate at all the inner half of the eyebrow because the supraorbital and supratrochlear neurovascular bundles are in the way. With your already high forehead, I would strongly consider a hairline or trichophytic browlift technique. That would achieve the dual effect of lifting the brows and shortening the vertical length of the forehead at the same time. Provided you have a good frontal hairline density, the resultant fine scar at the edge of the hairline is one that is usually not associated with any significant scar widening. I would not equate what can happen along the ears from a facelift to that of the effects of a browlift on the hairline. Excellent scars can be obtained, however, from each with good surgical technique.

Dr. Barry Eppley

Indianapolis, Indiana