Purpose

Managing pronounced brow ptoses remains a particular challenge, especially in female patients with rather sparse eyebrow hair. In such cases, a direct brow lift is rather unfavorable for cosmetic considerations. Meanwhile, transpalpebral brow fixation or suture-based endoscopic procedures might yield insufficient shorter-lasting results. For this particular patient population, a pretrichial hairline brow lift could be a viable surgical alternative.

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Methods

In this retrospective study, 14 cases of ptotic eyebrows in 9 female patients received a hairline brow lift (2023-2026, follow up time ≥3 months). This procedure was the first step of a two-stage approach, followed later by a standard upper lid blepharoplasty. The technique included a pretrichial zigzag-shaped beveled incision, frontal dissection in the subcutaneous plane, excess skin removal and wound closure. Functional outcome was assessed measuring the pupil brow margin distance (PBD) before and after surgery. Postoperative scars were checked for hair growth through and anterior to the scar. All cases were evaluated for complications.

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Results

The PBD changed from 16.9 ± 2.7 mm (mean ± SD) to 21.2 ± 2.7 mm corresponding to an average brow lift of 4.3 ± 1.3 mm. In unilateral brow ptosis cases, PBD difference between both sides decreased from 4.3 ± 1.4 mm to 0.9 ± 0.9 mm postoperatively, resulting in a high degree of symmetry. Hair growth through and anterior to the scar was observed in all cases making the latter less visible. All patients were satisfied with the barely visible scar appearance. There were no intra- or postoperative complications except for a slowly declining hypoesthesia of the forehead and anterior scalp in all cases, which lasted for 7 ± 5 months.

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Conclusion

The hairline brow lift seems highly effective for the studied cohort yielding results that are highly satisfactory from both a functional and an aesthetic standpoint. During the preoperative consultation, all patients should be explicitly informed that transient sensations of numbness are to be expected during the initial months, though they persist for longer periods only in isolated cases.

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Additional Authors

First name	Last name	Base Hospital / Institution
Philomena	Wawer Matos Reimer	Department of Ophthalmology, University of Cologne, Cologne, Germany
Constantin	Niederau	Department of Ophthalmology, University of Cologne, Cologne, Germany
Kira	Hilmers	Department of Ophthalmology, University of Cologne, Cologne, Germany

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