Subcutaneous brow lift with precise suture fixation and advancement

Current aesthetic literature reflects a renewed interest in the subcutaneous brow lift. The authors believe that this trend is based on the principle that the most direct approach to elevating the brows is subcutaneous dissection with skin advancement. Furthermore, the addition of progressive tension sutures (PTSs) to the subcutaneous brow lift permits precise fixation of brow position, controlled advancement of the forehead flap, and elimination of dead space.

The authors report on the use of active suture fixation of the brow and advancement of the forehead flap to accomplish a precise, effective, and sustained brow elevation.

Dissection was carried down to the frontalis muscle with a reversed bevel incision. Corrugator resection was performed by incising the galea transversely in the glabellar region and then identifying, isolating, and resecting the muscle. The first PTS was placed to secure the midline subcutaneous tissue to the superior edge of the transected galea. Then a PTS was placed from the subcutaneous tissue or deep dermis of the flap deep to the anticipated brow peak. The brow was anchored in an elevated position with additional PTS placed medially and laterally.

A consecutive series of 80 patients underwent the described procedure, with average follow-up of 13.5 months. One case of transient epidermolysis occurred, resulting in a small area of partial alopecia. Three patients had extruding sutures. Upper eyelid excision was required in 5 patients, and in 1 patient unilateral revision was performed to improve symmetry.

This approach simplifies the forehead lift and allows the surgeon to directly and precisely control the position of the brows, while shortening convalescence and reducing complications.