Concurrent brow lift and blepharoplasty with a resorbable
James Allan D’Silva
Ateesh Jayram Borole
Received: 11 June 2012 / Accepted: 3 September 2012 / Published online: 30 September 2012
Background Ageing changes on the forehead and the perioc-
ular area are of much concern to the patient not only from an
aesthetic but a functional point of view as well. Many techni-
ques exist for correction of upper periorbital ageing changes.
We hereby present our technique of doing a brow lift and
upper lid blepharoplasty as a combined procedure using a
resorbable fixation device.
Methods We carried out the study over a period of
36 months from July 2008 to July 2011. Only the patients
requiring both brow lift and blepharoplasty were included in
the study. Brow lift was performed through the upper lid
blepharoplasty incision, and elevation was maintained by
the resorbable fixation device screwed into the frontal bone.
Following this, excess upper lid skin and muscle was ex-
cised to complete the upper lid blepharoplasty.
Results A total of 25 cases including 17 females and 8 males
were operated. The age ranged from 39 to 74 years, and the
mean age was 54 years. Seven patients required both upper as
well as lower lid blepharoplasty along with a brow lift, whereas
18 patients underwent only upper lid blepharoplasty along with
a brow lift. In two of the patients who had a predominantly
medial brow ptosis, we placed the Endotine device over the
medial eyebrow. All patients were satisfied with the final result,
and the device became impalpable over a period of 1 year.
Conclusions The technique described is simple, reproducible
and quick for addressing the upper lid and brow in one
surgical sitting. A thorough preoperative discussion and dem-
onstration of achievable result to the patient along with thor-
ough understanding of the anatomy is the key to success.
Level of Evidence: Level IV, therapeutic study.
Ageing is a continuous process which becomes evident
by the various signs seen more prominently on the
face, such as prominent forehead creases, eyebrow pto-
sis, lower eyelid bags, malar ptosis, prominent nasola-
bial grooves, jowls, etc. These changes occur as a
result of increasing age, sun exposure, smoking, gravity
causing atrophy of skin components, loss of dermo-
epidermal papillae, atrophy of subcutaneous fat, etc.
Ageing changes on the brow and forehead are very
obvious and are of much concern to the patients as
they change the facial expressions giving a tired and
angry look to the face  such as prominent forehead
wrinkles, glabellar frown lines and brow ptosis which
is usually lateral but sometimes medial . Many tech-
niques have been described in the literature for the
correction of brow ptosis [3–5].
In 1919, Passot gets credit for the earliest description of a
technique for brow lift by excising an ellipse of skin .
Castanares and Vinas also performed lateral brow lifts by
excision of an ellipse of skin. The technique has been
modified and made more reliable by Glovanni  and is
still practised widely. After this, many new techniques have
evolved to achieve the best possible aesthetic brow rejuve-
nation with minimum morbidity. Coronal brow lift [8–10],
frontal hairline brow lift [11, 12], temporal brow lift ,
minimally invasive endoscopic brow lifts [13–15] and trans-
blepharoplasty brow lift  are some of these techniques.
The Endotine forehead fixation device (Coapt Systems, Inc.,
Palo Alto, CA), using direct or endoscopic approach, has
been described by many authors in the literature [17, 18].
We hereby present our experience in the use of this fixation
M. Thomas (*)
J. A. D’Silva
A. J. Borole
Cosmetic Surgery Institute,
Mumbai, Maharashtra, India
Eur J Plast Surg (2013) 36:213–218