"For the typical aging brow, I use what I call the modified lateral endoscopic browlift," says Richard Warren, M.D., clinical professor of plastic surgery at the University of British Columbia and medical director of the Vancouver Plastic Surgery Center.
"My feeling and experience are that the endoscopic browlift does a good job with raising the medial brow, but not the lateral brow. My feeling is that the shape we are creating isn't optimal, and that we should be doing something different to lift the lateral end of the brow," Dr. Warren explains.The technique Dr. Warren's technique combines the endoscopic browlift with an open approach in the temple. Sensory nerves are dissected and preserved. He says that he reviewed 50 endoscopic browlifts before adopting this modified version of the technique.
Endoscopic browlifting involves using an endoscope to create tiny incisions with typically less bruising and less discomfort than with a coronal browlift. An older procedure, the coronal approach involves an incision in the scalp from ear to ear over the top of the head.
According to Dr. Warren, the coronal browlift is quite effective, but brings with it a greater degree of complications because of the length of the incision.
"There is a long incision made over the top of the head," Dr. Warren says. "Patients have complained of numbness, itchiness and hair loss. With the endoscopic browlift, patients can get hair loss, but it's just around the punctures, and the chance of numbness is much less."
Alternative technique Bahman Guyuron, M.D., says the endoscopic browlift is not suitable for every patient, which motivated him to develop an alternative technique.
"One procedure does not fit everybody," says Dr. Guyuron, clinical professor of plastic surgery at Case Western Reserve University in Cleveland and a plastic surgeon in private practice. "For patients who have a long forehead or a receding hairline as a result of hair loss, we offer a procedure which shortens the forehead."
Dr. Guyuron reduces the distance between the eyebrows and the hairline by placing a curvilinear incision at the hairline and repositioning the hair-bearing scalp anteriorly and caudally. Stepwise releasing incisions are made in the galeal fascia to allow for greater advancement of the hairline. Three fixation PDS sutures are passed distal to each relaxing incision and fixed to the cranium using a bone tunnel to advance the scalp.
The excess forehead skin is resected at the anterior hairline. In addition, Dr. Guyuron uses CO2 laser to go over the incision to minimize the visibility of the scar. This procedure has been performed on many patients since 1992 and complications associated with the technique have been minimal. Hair loss may occur as a result of the administration of local anesthetic containing high concentration of vasoconstrictive agents that shocks the hair follicles.
"The most common complication that I have observed is minor patchy hair loss," Dr. Guyuron says. "However, that hair loss is only temporary."