This procedure is reserved for patients who will be undergoing upper blepharoplasty (or upper eyelid skin, muscle, and/or fat excision) and have very little excess skin in the forehead, have little in the way of cross-forehead creases, but do have significant brow droop (brow ptosis). It may also be used in cases where skin and creases are present, but the patient only wants to address brow position, and through the least invasive approach. Marks are made to outline the amount of skin to be removed from the upper eyelids. The skin is excised, along with muscle, and possibly fat. Excess is gained to the space under the eyebrows, and over the skull bone. Adequate release is assured by elevating the skin and witnessing re-positioning of the eyebrows in a symmetric fashion. Two symmetric drill holes are made in the outer portion of the skull. This is done with a drill bit that is protected from entering too deep into the bone. The fixation devices are deployed. They look like plastic hang-hooks. The skin is re-draped over the hooks in the desired position. A compressive dressing is then applied to allow the forehead soft tissues to scar in the appropriate position.
Jacob Gerzenshtein, MD, FACS,
A Board Certified Plastic Surgeon
