Reversing brow lifts.

Abstract

Undesirable brow shape and position may occur after brow lift surgery. Problems can include overelevation of the brows, separation of the brows, and creation of an apex medial slant brow shape. We report on a procedure to restore or improve presurgical brow shape and position. Brow lift reversal surgery was performed with open approaches. Anterior and posterior scalp flaps were developed in a subperiosteal plane. The lowered medial brow was sutured to the frontal bone with an anchor system. The repositioned anterior hairline was secured in a similar manner. The scalp defect that results was closed by advancing the posterior scalp flap. Galeal scoring was sometimes necessary to increase the length of the posterior flap. Twenty-two women (average age 45 years; range 32 to 62 years) presented for correction of their brow position and shape after brow lift surgery. All brows were lowered, and the brow apex was shifted laterally. The medial brow was lowered 3 to 10 mm (average, 6 mm) relative to the intercanthal line. The anterior hairline was lowered 5 to 18 mm (average 12 mm). The repositioning has remained stable over 6 months to 3 years' follow-up. No revisionary surgery has been requested. Two patients had areas of alopecia develop in the posterior scalp flap. The surgically lifted brow can be lowered and reshaped by advancing, repositioning, and fixing the frontal scalp to the skull.