Revisiting Browpexy As An Adjunct to Blepharoplasty: Introduction of the Lateral Brow Retaining Apparatus

Goals/Purpose:   Increasing investigation  of the surgical anatomy of the periorbital region has resulted in increasingly varied and sophisticated surgical techniques for periorbital rejuvenation.  Since McCord and Doxanas in 1990 first described the surgical technique of transpalpebral browpexy through the blepharoplasty incision, the importance of addressing eyebrow position in aesthetic blepharoplasty surgery has evolved to considerations of the eyebrow and upper eyelid as irrevocably connected, as shown by the increased use of neurotoxins.  The authors describes long term experience with a combined upper blepharoplasty and broxpexy procedure, as well as modifications which enhance this technique for periorbital rejuvenation.

Methods/Technique:   The authors retrospectively reviewed the case records of 73 patients who underwent combined upper blepharoplasty with transpalpebral browpexy performed by the senior author (JWF).  Review of the data reveals two technical modifications which consisted of release of the lateral brow retaining ligament for effective redraping of the periorbital tissues and lateral wedge excision of the preorbital orbicularis oculi to efface lateral crow’s feet.  Inclusion criteria included a minimum of 24 months follow up.

Results/Complications:   The average age of patients was 54.7 years, of which 84% were female and 16% male.  The average length of follow-up was 35 months.  Data from the entire series revealed absence of revisions and no cases of frontal branch nerve injury, hematoma, or post-operative asymmetry. 

Conclusion:  The common goal of periorbital rejuvenation procedures is to provide a long-lasting and natural aesthetic result.  The combined upper blepharoplasty with browpexy procedure yields excellent long-term results with minimal complications and downtime.  The authors’ modifications of browpexy in combination with blepharoplasty provides a technique which enhances the results of upper eyelid surgery by augmenting the longevity of the blepharoplasty and addresses lateral brow ptosis by providing a mechanism for decompression of lateral hooding.