"I call it the tricophyllic browlift procedure because its hair-friendly," Dr. Taylor said at the American Academy of Cosmetic Surgery (AACS) meeting here.
Traditional browlift With the traditional browlift, the incision was traditionally placed right at the hairline, and it destroyed the zone of diminishing follicular density."If there's any loss of hair follicles whatsoever, the incision is left in front of the hair," Dr. Taylor says.
"With the tricophyllic procedure, we're essentially performing a forehead and browlift with an incision placed just inside the hairline, and designed in such a way that the hair follicles regenerate through and in front of the incision, making it imperceptible to the naked eye," Dr. Taylor says.
"The other advantage of this technique is that we do not move the hairline in a posterior direction, so there is no elongation of the forehead which (sometimes) occurs," he adds.
Dr. Taylor says the procedure actually shortens the forehead, because the brows are elevated.
"We can approach the elastic limits of the skin by being in the subcutaneous plain so we do not see the sensory disturbances common in other lifts," he explains. "We perform this superficially to the motor and sensory nerves in the forehead, and because of the reverse bevel design of the incision, which allows the hair follicles to regenerate through the incision, the hairline is not an abrupt cessation of hair follicles, which is what you see with a hairpiece," Dr. Taylor says.
Procedures vary "In some approaches, the incision is placed right at the hairline. In the coronal browlift, its placed about 5 to 6 cm behind the hairline ... across the top of the head," he says.
The procedure is popular "because the incision is camouflaged in the hair," but there are numerous problems, he adds.
Drawbacks Drawbacks of the coronal procedure include posterior movement of the hairline posterior, because the incision is placed on top of the head, pulling the hair and the forehead back.
Another popular way of doing browlifts involves the use of an endoscope.
"The endoscopic approach involves five slit-like punctures across the top of the head. The disadvantages include elevation of the hairline, and that long-term stability in certain patient populations has not been shown, so that the procedure is utilized more extensively in a younger patient population," says Dr. Taylor, who also noted that the endoscopic approach involves expensive technology.
Alternative approach In Dr. Taylor's subcutaneous approach, "we create a subperiosteal plain in the middle of the forehead so as not to disturb the sensory nerves. Through this tunnel, I then resect the corrugator musculature and then close that inverted 'V' incision," he says.
Dr. Taylor has performed the tricophyllic browlift procedure on hundreds of patients over the past 15 years, all under direct vision with fiberoptic lighting.
"Other people have described the trichophyllic incision, but I am the only one who has developed it in the subcutaneous plain," he says.
"The only patient that would represent a contraindication would be the rare patient with an extremely low hairline," Dr. Taylor says. "Occasionally you will find women with low, almost masculine hairlines. In those cases I will go behind the hairline to perform the traditional coronal approach, or if they're young, an endoscopy, to actually pull that hairline back. That patient represents probably less than 2 percent of patients I see," Dr. Taylor says.
Disclosure: Dr. Taylor reports no financial interests in this story.