Transpalpebral Brow Lift During Blephaplasty

I understand your concerns regarding hairline and scar alopecia, but compromising on the best operative approach to avoid the scar may end up giving an inadequate lift that often does not last (if it even makes a visible difference in the first place). Previous scar alopecia may be related to surgical technique and/or suture material choice rather than "your" innate scar healing (stretching).

You may also find that a proper bicoronal or trichophytic (hairline) incision forehead lift will lift the brows into the "proper" aesthetic position, reducing the pseudodermatochalasis (pseudo-excess upper eyelid skin) and eliminating the need for upper lid blepharoplasty (or as much skin resection as previously thought). The hairline incision can actually lower your hairline, improving your "high forehead" at the same time as lifting your brows!

While I have performed transpalpebral brow lifts in selected patients, I find that the results often do not live up to my patients' expectations, or my own standards, so this is an operation I rarely recommend. And although I have taken several endoscopic forehead lift courses over the years, and respect those surgeons who can achieve good results with this technique, I find that in my hands a bicoronal or hairline lift (with proper and precise suture closure technique) leaves a better and more long-lasting result, and a longer but much less visible scar (usually without alopecia or scar widening) than multiple endoscopic "puncture" incisions that actually end up being more visible and unsatisfactory than the scars they purportedly are designed to improve upon! You can also have the upper eyelid results "messed up" with the additional manipulations needed to perform the browlift through these incisions.

Consider consultation with several ABPS-certified plastic surgeons before making your decision. Best wishes!

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.

I frequenly include this in my upper lid blepharoplasties because I think it does make a difference. It avoids the hairline and scarring concerns and can improve the surgical outcome. Great question. Clearly, there is more than one option in facial rejuvenation surgery and you are wise to research various options to enable you to discuss them with your plastic surgeon.