Is Pretrichial Brow Lift Possible if There is NO Forehead Skin After Coronal Brow Lift?

One eyebrow is almost 1 inch lower than other brow after paralysis of frontalis nerve following coronal lift 2.5 years ago. Can the pretrichial lift achieve the goal of brow lifting when there is NO skin on forehead to pull up as extra skin is only above the brow? I will not have a direct brow lift due to scar and there is NO wrinkle or crease to hide a forehead scar. This is only option. Is there danger of necrosis from the coronal scar? Other problems? I cannot take any more mishaps.Need wisdom.

Doctor Answers 7

Is Pretrichial Brow Lift Possible if There is NO Forehead Skin After Coronal Brow Lift?

     I would use a bone anchor or something similar to take care of the residual skin laxity above the brow.  The same incision or a partial hairline incision could be used as well as endoscopic portals - you could choose.  This can be accomplished with any number of procedures.  There should not be an issue with tissue compromise or viability.  Kenneth Hughes, MD Los Angeles, CA

Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Hairline Browlift after Coronal Browlift ??

It is possible to do a hairline browlift but you are rightly concerned about the circulation to the intervening scalp between the two incisions. Whether this should be done would depend on knowing exactly where the coronal incision is (distance between it and the frontal hairline) and seeing the differences between the two brow positions. Pictures would be critical to better answer your questions.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 reviews

Yes it is possible

The main concern here is the circulation of the scalp between the two incisions.

An in person examination of the incisions is important, and planning of the pretrichial incision can be done to minimize risk to the anterior vessels that may be helping in the blood supply of the scalp.

I've done this before on a few occasions with no problem, but I do discuss the risk with my patients before hand.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 37 reviews

Pre-Trichial Brow Lift

There is no reason to ever do a "pre-trichial" brow lift, which means the incision is made in front of the hairline. It is better to do a "trichophytic" incision in the hairline where the hair will hide the incision scar.  A partial hairline incision is possible but will be limited because of the previous coronal incision which has compromised circulation. Pictures will help me answer your question.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Raising one brow after coronal lift and paralysis

If you had a true "coronal" lift ,with the scar greater than 5cm behind the hairline, a partial trichophytic brow lift could  be done to improve your situation.  If the old scar is just behind the hairline, there may be some concern for circulation to the skin between the new and old scars. the tightness of the upper forehead you describe may not be a factor if the surgery can involve dissection down to the looser brow tissue which can be suspended  and fixed to the frontal skull bone. It should stay in position if there is a true paraylsis as you describe.  You  have to be seen in person to be properly evaluated.  

Sheldon S. Kabaker, MD FACS
San Francisco Facial Plastic Surgeon
4.4 out of 5 stars 35 reviews

Trichophytic or Coronal Brow Lift

Although a photograph would be much more helpful in answering this question, a trichophytic or pre-trichial brow lift are not ideal in the setting of a low hairline.  Generally speaking, for patients with a facial nerve injury, a direct or midbrow lift allows for the most control of brow positioning.  A skilled Facial Plastic Surgeon should be able to perform a very cosmetically acceptable procedure with minimal scarring.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 93 reviews

Yes a pretrichial brow lift is possible to correct brow position

As long as there is some laxity of the skin in the region of the lower positioned brow, a pretrichial brow lift can be very effective in correcting asymmetry of the eyebrows. Because circulation in the scalp and face is so robust it is unlikely that you will experience necrosis of the skin.

Randy B. Miller, MD
Miami Plastic Surgeon
5.0 out of 5 stars 19 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.