Transpalpebral browpexy

Transpalpebral browpexy could be performed as an adjuvant procedure to the upper blepharoplasty or as a separate procedure. It is done by separating interdigitalizing connections between the orbicularis and frontalis muscles, moving the orbicular part of the orbicularis muscle with overlying brow to the more cephalad position and again uniting both of these muscles with nonresorbable sutures in a new higher position. During the years 1990 to 1999, 55 patients (47 women and eight men) were operated on with this technique, which was partially developed by the author. Additional time required to achieve transpalpebral brow stabilization during standard blepharoplasty was approximately 30 minutes. Forty-three patients were followed, 38 of them for longer than 4 years. The elevation effect gradually decreased but persisted, with wide variations, between 1.5 and 7 more years. At the last follow-up examination, 36 of 43 patients had maintained lateral brows in the same position as before operation and sometimes even higher, which was appreciated by the patients. Complications were very few and they were correctable. Transpalpebral browpexy proved to be a useful addition to blepharoplasty and can be used for the minor adjustments after an open coronal or endoscopic brow lift. Particular indications included patients with lateral brow ptosis and discrete forehead wrinkles and balding men.