Is there a Brow Lift That Suspends the Brow by Drilling into the Bone?

Have you ever heard of a brow lift where the brow is suspended by drilling into the underlying bone? I would like a lateral brow lift from a temporal approach but do not want endotines. Is drilling into the bone at the brow safe? It seems like it would increase the risk of nerve damage. And is there a way to remove excess forehead skin from the temporal approach? How would you lift the lateral brow if you weren't using endotines or a coronal technique? The transbleph browpexy did not hold up for me.

Doctor Answers 9

Bone anchoring

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about 2 decades ago there was a big movement to make a minimal incision brow lift and anchor the brow to the outer table skull bones via a suture, and then an absorbable clip was developed.  these techniques have advantages and disadvantages.  depending on your circumstances, sometimes the older technique of scalp/skin excision combined with fixation to more superficial tissues will best serve the patient.  

the best way to tell is to discuss this with a surgeon experienced in both techniques

Elkton Facial Plastic Surgeon

Fixation for the Temporal Brow Lift

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First, I'm sorry you went through the internal brow pexy.  I think this procedure is best used as a preventative measure.  I perform this on all of my upper lid blepharoplasties to prevent descent of the brow.  As far as a temporal brow lift there is no need for bony fixation.  Once a thorough dissection and freeing up of the tissues is performed the brow can be easily fixated to the deep temporal fascia with long lasting dissolvable suture.  The tissues actually "stick down" to the bone within a few days so bone fixation is not necessary.  The real key is to fully free up the tissues.

Lateral brow lift

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In addition to the many excellent opinions already given here I would add a lateral , temporal subcutaeous brow lift with skin excision inside the hair line without need for bone fixation.

Andrew Pichler, MD
Sacramento Facial Plastic Surgeon


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Endoscopic browlifts which avoid a large incision and do not involve removing excess skin work by redraping the brow and forehead soft tissue in a higher position against the skull. To maintain this position, they are fixated to the bone through shallow holes drilled into the bone. It is very safe and is not "neurosurgery". That is the the hole that is drilled is not full thickness through the skull.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

In a brow elevation, is a small hole drilled into the skull bone?

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Sometimes it is necessary to elevate the eyebrows in order to help provide definition to the upper eyelids. There are a number of techniques that can be helpful in elevating the forehead skin and the brows. When larger skin incisions are used, then sutures to the tissue near the incisions suffice to hold the new position. When smaller incisions (endoscopic assisted) are made, then sometimes a small shallow hole is made in the outer bone layer to help stabilize the skin with either a tiny screw or absorbable plate. Small tunnels have also been used. But another option to avoid the small bone holes is a suspension suture placed behind the incisions and buried under the hair-bearing scalp.   When the lateral (outer) brow is the main focus-and it often is- then the incision is made in the  the temple region, and sutures alone provide adequate fixation. Not every patient needs brow elevation with aging but it when necessary, the least invasive option might the place to start discussion with your surgeon.

Donn R. Chatham, MD
Louisville Facial Plastic Surgeon
5.0 out of 5 stars 75 reviews

One method of fixating an endoscopic browlift is to drill holes in the outer layer of the skull bone

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One method of fixating an endoscopic browlift is to drill holes in the outer later of the skull bone. This is a safe option. The skull is thick and composed of two separate layers. The main issue with this type of browlift is not drilling holes in the outer layer of the skull bone but the extent and durability of the endoscopic lift. Many surgeons, myself included, have gone back to gold standard "open" browlift approaches such as the trichophytic and coronal lifts because the offer more precise brow lift and shape and the results are more predictable and durable.

Stephen Weber MD, FACS

Is there a Brow Lift That Suspends the Brow by Drilling into the Bone?

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This is a form of internal fixation, of the lifted eyebrow tissues, used in an Endoscopic Brow Lift.  IMHO, these suspension methods are far more prone to becoming loose than the Coronal Brow Lift that actually removes tissues allowing the eyebrows to remain elevated.  For this reason, the Coronal Brow Lift is considered the gold standard of Brow Lifts.  

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Browlift and bone drilling vs. the Irregular Trichophytic Forehead Lift.

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Browlift and bone drilling vs. the Irregular Trichophytic Forehead Lift and which gives the best results. As the co-inventor of the ITF lift I have a long history of using both. Yes, the bone can be drilled and the forehead lifted without an endotine. However, the reason we invented the ITF forehead lift 35 years ago is: 1. It gives the most reliable forehead lift  2. No hair is removed  3. The resultant scar if properly done does not show 4. The hairline can be lowered  5. The entire brow is raised creating a rested look, unlike the lateral temporal browlift which can create an evil look since it does not raise the medial brow!

So what is the downside?? Temporary numbness of the scalp behind the incision for 6-12 months. I have never revised a hairline or been asked to do so. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Lateral browlift

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A lateral browlift can be done through a 1 inch midforehead incision or a larger incision in the lateral scalp. Subcutaneous dissection in carried down to the orbicularis muscle under the brow. The muscle is sutured to superior tissue to raise the brow. I gave up on both endotines and transbleph browpexy because of the lack of consistent results.

Peter T. Truong, MD
Fresno Oculoplastic Surgeon
4.9 out of 5 stars 43 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.