II. ADJUNCTIVE PROCEDURES

II.D. Browlift

2. Coronal Browlift

A coronal browlift is performed by making a long incision in the scalp behind the hairline. An exact amount of scalp tissue is removed, the forehead tis­sue is lifted, and the incision is sewn together. This repositions the brow upward, causing the "lift." The coronal browlift is a reliable approach for achieving browlift and is a commonly used approach. In a female patient without any thinning of hair, it is a nice way to address moderate to major brow drooping, as long as the patient understands that she will have some numbness from just behind the incision to the top of her scalp. This is usually temporary, resolving over a period of several months, but in some cases it can be longer lasting or even permanent.

In men, the coronal browlift is not commonly used because of the likelihood of balding. With balding, the scar would become exposed. In men, the coronal browlift is only considered if they have a thick head of hair with no family history of balding, and if they meet other criterion for coronal browlift. The coronal browlift will raise the hairline, so if a patient already has a high hairline, another approach may be prefer-able.

3. In-Front-of-the-Hairline Browlift

An "in-front-of-the-hairline" browlift, known by sur­geons as a pre-trichophytic lift, is the approach used in women who would be candidates for a coronal brow-lift, except for the fact that they have a high hairline. The incision typically heals well, is extremely well hidden, and is rarely a problem for the patient. The same considerations regarding numbness and balding apply here as for the coronal browlift.

4. Midforehead Browlift

A midforehead browlift is especially effective in male patients with a prominent forehead crease and is in women with prominent forehead creases as long as they understand that they will have scars on their forehead that will be hidden within the crease but that

will be a little more prominent while they are healing (a period of several months). Women who can accept this are actually good patients, because they are more likely than males to camouflage the scars with makeup during this normal healing process.

In this approach a precise amount of skin is re-moved and the incisions are stitched closed, thereby elevating the brows as desired. At times, absorbable "suspension sutures" are placed deep beneath the skin to provide additional support during the healing pro­cess. The midforehead browlift is easily performed under light sedation and even local anesthesia. The numbness described in some of the other lifts is not typically a consideration. The main drawback of this approach is the incisions, which becomes a nonissue if the patient has forehead creases and understands and accepts the placement of incisions in these creases.

Most browlifts are performed under sedation anes­thesia or general anesthesia. In an occasional patient undergoing a mid-forehead browlift, the surgeon may use local anesthesia only. It is generally not necessary to cut any of the patient's hair. Some swelling and bruising are normally present after browlifts, but the degree of each varies widely from patient to patient. Generally, most patients appear quite sociably accept-able within 10-14 days after surgery.

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