Q: Dr. Eppley, I am interested in a novel browlift reversal procedure and I suspect if anyone can do it you can. A few years ago I had a brow lift performed. I hated the result. I felt like it stretched out the skin over my forehead too tight, making the bone underneath more prominent. I know in a typical scenario you might recommend a forehead reduction or some sort of burring. I however had a unique idea. I notice that in a few cases you mention the use of screws to hold the skin to the bone. I notice that when I push my scalp foreword toward my face, my forehead skin returns to the place it used to be. I was praying and hoping that you might be able to use that screw mechanism or whatever it is to hold my scalp in the forward position, returning it to its original position and thereby avoiding the forehead reduction, which I am not willing to even consider. It would mean the world to me if this could be done. I am desperate and in emotional pain. If you could make this happen it would be a God-send.
A: What you are describing is pretty much how a browlift reversla procedure is done. The very fact that you can do adequate mobilization of the forehead downward by pushing on the scalp suggests that is a real possibility to reverse your browlift. The concept of resorbable screw or suture anchor fixation to hold the released forehead tissues down is just as valid as using it to hold a browlift up. The only question then is what incisional approach to use to do it. What type of incision was used to do your browlift, endoscopic (which I assume), pretrichial, or coronal??
Using your existing endoscopic incisions (which are either two or three), the entire forehead and brows as well as the scalp behind them can be released. Then the scalp is advanced forward (epicranial shift) and is secured forward (pushing the forehead and brows down) by two or three point resorbable screw fixation to the frontal bone. I would anticipate this approach to a browlift reversal to work quite well as it is just a form of hairline/scalp advancement.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested on finding out if a browlift I had done can be reversed or a brow lower ing procedure be done. About one year ago I had an aggressive endoscopic browlift done in which afterwards has lifted my eyebrows way too high. I only had a minor brow sagging problem beforehand and was borderline for the procedure anyway. My surgeon told me they would eventually drop but have not done so and if they have it is clearly not enough. I look like the proverbial ‘deer in the headlights’ look compared to what I looked like before surgery. Can this overdone browlift be fixed in your experience?
A: Excessive brow elevation from an from an overdone browlift can be treated by observation for 3 to 6 months or a brow lowering procedure. Most overlifted brows will usually relax to an acceptable level. But if not, a brow lowering procedure can be done with a subgaleal dissection release combined with an intraoperative tissue expansion manuever. Using a small tissue expander placed in the mid-forehead, it is inflated to its maximum volume to aid with the subgaleal release. Done together, a browlift can be reversed.
Dr. Barry Eppley