Anatomic concepts for brow lift procedures.

Background: Brow lifting became a component of the facialplasty procedure 45 years ago, and the original brow-lifting technique incorporating a coronal incision approach is still practiced by many surgeons today. Over the past 15 years, however, the endoscope-assisted procedure and the limited incision, nonendoscopic techniques have evolved as alternate procedures for brow lifting. The level of artistry in performing any brow lift technique is raised when the surgeon acquires knowledge of upper facial anatomy and integrates that knowledge into a working concept of the aging process of the upper face.

Lateral open forehead lift.

The lateral open forehead lift technique uses 2 scalp incisions to elevate and suspend the lateral eyebrows, and 2 upper blepharoplasty incisions to access the muscles that produce glabellar frown lines and depress the medial eyebrows. Advantages of this technique are that side effects associated with the coronal incision, such as hair loss and overelevation of the medial eyebrow, are avoided.

The superficial lateral canthal tendon: anatomic study and clinical application to lateral canthopexy.

Most patients who undergo facial cosmetic surgery procedures that could cause lower eyelid retraction or ectropion should have an additional surgical procedure to support the lower eyelid and lateral canthus. The lower eyelid should be supported when performing laser planing of the eyelid; midface elevation through a lower eyelid incision approach; or conventional blepharoplasty, in patients with lower eyelid laxity. Suspending the lateral canthus by surgically altering the lateral canthal tendon is a proven technique that can provide support for the lower eyelid.