(Female/47) Two years ago, I had a mid-face and neck lift along with excision of xanthalasma, around the inner upper/lower orbital area, with good results except alopecia began above my ears as the scars widened. (I wear my hair in a short wedge with bangs. I have a high forehead.) I'm now perimenopausal (low prog and test) taking BIO hormones. Thoughts on a upper bleph and transpalpebral brow vs endo lift given my now hooded eyes and hair loss concerns? Lateral brow is above orbital bone.
Transpalpebral Brow Lift During Blephaplasty
Doctor Answers 10
Endotine Direct (Transblepharoplasty) Browlift is a Reasonable Compromise
It sounds to me that you are in the "less is more" approach to cosmetic surgery. I have experience with the Endotine Direct Browlift, in which the brow is raised from an upper eyelid incision. Thebrowlift results are improved by the use of an implant made from a carbohydrate which eventually resorbs, but does hold the eyebrow against gravity until the healing is complete. I find it important to use Botox before and during the healing to minimize the downward pull of the muscles around the eyebrow. Although some other approaches are more dramatic, you can get the 'most with the least' with this technique, esp., if you are younger and with good skin tone.
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Transpalpebral Brow Lift with Upper Blepharoplasty
If you have brow ptosis with a high hairline I suggest you have a Irregular Trichophytic Hairline Brow Lift, a technique we described many years ago. With this approach, we make an incision at the hairline which enables us to lower your hairline when elevating your brows. We bevel the hairline incision so hair will grow through and in front of the resulting scar so it will not be seen.
Brow lift for high hairline
If you have a high forehead your best and longest-lasting bet is a trichophytic hairline brow lift - even with thin hair the incision typically heals very nicely.
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Transpalpebral brow lift
Transpalpebral Brow Lift?
Photos of your eyes and eyebrows would be helpful in your evaluation. Transpalpebral brow lifts are far less effective than proper Brow Lifts and you might want to have several consultations to discuss your particular case.
Consider an endoscopic browlift
I have tried these transpalpebral browlifts and am always underwhelmed by them. They use the premise of pushing and resting the brow and with time and gravity they tend not to hold up well. The endoscopic brow lift works well and like other successful browlift methods they tend to pull and not push the brow upwards and allow for a more thorough dissection of th etissue with release of the tissue that is preventing it from coming up.
The transpalpebral browlift is very disappointing.
This procedure is primarily used at the time of functional blepharoplasty in an attempt to provide inexpensive browlifting. Attempt being the operative word here. If you need brow lifting, the endoscopic brow lift is the answer. I would recommend this approach and then consider having hair grafting to improve your focal hair loss.
Transpalpebral Browlift Produces Only A Minimal Lifting Effect
While a transpalpebral browlift avoids any hairline scars, the 'price' to be paid for that decision is that it does a relatively poor job of lifting the brow. At best, it can only make a minor elevation of the tail of the eyebrow. It illustrates a basic principle that you can't really lift much when all you are doing is pushing up from below. With your already high forehead, I would strongly consider a hairline or trichophytic browlift technique. That would achieve the dual effect of lifting the brows and shortening the vertical length of the forehead at the same time. Provided you have a good frontal hairline density, the resultant fine scar at the edge of the hairline is one that is usually not associated with any significant scar widening.
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