Q: Dr. Eppley, I am interested in temporal implants but I have a twist to my need. I am bald and can’t regrow hair so I keep my head shaved. In addition I had a direct browlift last year so there are healed incisions right above my eyebrows. My question is can these implants be placed by going through the brow incisions? I hate that I would need temporal scalp incisions which would be very visible in someone like me.
A: While temporal implants may be aesthetically beneficial for you the question is how to get them in there in a ‘scarless’ manner in someone who shaves their head. This is a unique male question and not one that is seen in females. As you have read, the approach for temporal implants is from a 3 to 4cm incision just above the ear. While that approach makes it very easy and simple to do, the concept of a fine line scar in shaven scalp skin does give me pause. Your question of whether a temporal implant can be placed through a direct brow lift incision is an interesting one and the presence of a scar in that area poses a unique ‘opportunity’. The eyebrow incision for temporal implants is one I have never done and I doubt if it has ever been done anywhere in the world to date. By its proximity your eyebrow scars provide direct access to the area of temporal hollowing but the attachment of the temporal fascia to the lateral orbital bone is quite stout and would have to be released to gain entrance to the subfascial temporal plane. (having done a lot of craniofacial surgery I am very familiar with doing surgery in this area) The simple answer to your question is that it is theoretically possible and if one was doing some adjustment of your direct brow lift anyway there is no reason not to try. If it becomes too difficult to do, one can always then switch to doing fat injection into the muscle and on top of the fascia to create a temporal augmentation effect.
Dr. Barry Eppley
Q: Dr. Eppley I had a direct brow lift done for which the surgeon decided to alter the Orbicularis muscles. This has been catastrophic to me and my surgeon doesn’t know how to fix it now. I would like to repair or clean this up in some way shape or form. The most noticeable problem is at the outter corners of the eyes and at the temples. From the temple area at about brow bone level the removal of support has caused this area of my face to drop down and slid inward toward as if towards the nose. My ENT doctor says this “dropping” is also causing my new sinus problems because of the sinuses at the maxillary sinus. Is there a procedure to repair this sort of thing? Any information to help direct me would be extremely appreciated. Thank you for your time. Sincerely and hoping for good news.
A: In answer to your questions, I first assume by a direct browlift you mean where the incision was placed directly over the brow. I will make that assumption in my comments:
1) A direct browlift does not disturb the orbicularis muscles. They are outside of the excisional zone of a direct browlift. Most likely the effect you are seeing is that once the brows are raised, the unlifted areas (corner of the eyes, temples) now looks by comparison sunken in and drooping downward. A direct browlift would not cause loss of support of these areas. It is a very limited procedure that, unlike all other types of browlifts, does not change anything around it. A temporal lift is the solution to uplifting these apparently ‘fallen’ areas.
2) Any drooping tissues around the eyes is not making any contribution to a maxillary sinus problem. That makes no anatomic sense whatsoever.
Dr. Barry Eppley