Pretrichial Brow Lift

Patients often come in with "droopy eyes" complaints, which refer to many issues. One common issue is upper eyelid dermatochalasis, but there may also be pseudoherniated fat or lacrimal gland ptosis. As people age, blepharoptosis, drooping of the eyelid, is common. Still, patients may not consider how brow ptosis, drooping of the eyebrow, can contribute to an aged appearance and even affect their vision. Surgeons must thoroughly evaluate the periorbital area to determine the best approach for each patient, including whether or not to perform a brow lift in conjunction with upper eyelid surgery.  Since Passot's first surgical brow lift in 1919, many techniques have been developed to improve results. The traditional coronal approach was the first modern approach, followed by trichophytic and pretrichial variants. Direct, midforehead, temporal, endoscopic, and transblepharoplasty approaches were developed over the next 70 years. As technology in facial plastic surgery has advanced, and minimally invasive procedures have become more popular, endoscopic and transblepharoplasty techniques have gained popularity over open approaches. However, coronal incisions and their variants are still useful in certain situations. The choice of approach depends on whether any adjustment to the frontal hairline is necessary. A traditional coronal approach will commensurately elevate the hairline with the scalp strip's width excised. Pretrichial/trichophytic approaches tend not to elevate the hairline and may even be used to lower it if necessary. The choice between pretrichial and trichophytic approaches is generally based on surgeon and patient preference. The pretrichial approach places the incision directly anterior to the hairline, whereas the trichophytic approach runs a few millimeters posterior to the hairline to hide the scar. In some cases, such as for hairline adjustment, the incision may run partially anterior to the hairline and partially within it. This article will discuss the pretrichial brow lift approach and its benefits and limitations.