Procedure and recovery
The approach is through a one and a half inch curved incision well concealed behind the frontal hairline. In most patients with a high forehead or in males with a receding hairline, the incision is placed at the frontal hair line. The dissection is carried out behind the frontalis muscle of the forehead. The fibrous attachments of the brow are released from the upper rim of the orbit. The tiny supraorbital and supratrochlear nerves above the brow are carefully protected. The tip of the instrument is carefully used to strip the corrugator muscles from their deep dermal attachments beneath the vertical “frown lines” and the procerus muscle attachments to the nasal creases at the root of the nose. Traction is placed in a vertical direction on the forehead until the arch of the brow is slightly above the arch of the supraorbital rim. A crescent of the frontal scalp skin is excised and approximated with surgical staples. No extra hair is trimmed during the closure. Symmetry of the brow position is achieved by minor adjustment on either side.
The scalp incision is well concealed. Hair can be combed or brushed back directly over the incisions with a wide toothed comb or a soft brush. A slight degree of numbness may be experienced in the mid-scalp region but the new nerve ingrowth usually occurs within several weeks. On occasion, a slight degree of weakness may be experienced in the frontalis muscle, but over a period of time the muscle redevelops is strength and the eyebrow symmetry is achieved. Tints, dyes, and irritating skin-care products should be avoided for at least three weeks post surgery and a hairdresser should be advised that the incisions may be tender for two to three months.
