What Does a Pretrichial Brow Lift Do?

Excess sagging skin around the forehead causing drooping of the brows and wrinkling of the forehead is removed. A pretrichial brow lift can also be combined with a facelift.

A pretrichial brow lift is a surgical procedure to correct the loss of soft tissue elasticity in the upper third of the face. The pretrichial brow lift is usually performed by plastic surgeons.

Excess sagging skin around the forehead causing drooping of the brows and wrinkling of the forehead is removed. Underlying muscle and tissue are repositioned, creating a more refreshed, youthful appearance in the upper third of the face.

A pretrichial brow lift can also be combined with a facelift.

Aesthetically, the face is divided into three equal parts, of which the forehead (from the top of the eyebrow to the anterior hairline) occupies the upper third. In males, this area averages 7 cm. In females, it averages 5 cm.

The male eyebrow is less arched than the female eyebrow. The top of the eyebrow lies approximately 2.5 cm from the mid pupil.  With aging, these parameters may shift. A lesser distance denotes eyebrow drooping (ptosis). Loss of forehead skin elasticity from genetics, solar damage, and gravity causes eyebrow and upper eyelid drooping.

Aging also causes depletion of the subcutaneous fat with deterioration of the subjacent skull bone. This leads to forehead wrinkling.

Patients may seek this surgery to correct:

• A tired, surprised, worried, or annoyed appearance
• Aged appearance
• Drooping (ptosis) of the eyebrows
• Wrinkling of the forehead

• General systemic conditions (such as diabetes) and bleeding disorders.
• People with an inability to completely close the eyes (lagophthalmos).
• Psychosocial deficiency.
• Unrealistic expectations (must be dealt with preoperatively).

Before the surgery

• The patient must discontinue use of aspirin and similar medications at least two weeks prior to surgery and for two weeks postoperatively.
• The position of the hairline, eyebrow, and upper eyelids is carefully noted manually, locating the eyebrow position and observing the effect on the upper eyelid.
• The sites of forehead wrinkles are recorded.

During the procedure

• The surgery is usually performed under general anesthesia.
• Shaving is not necessary.
• Incision follows 2 mm behind the hairline, helping induce hair growth through the incision.
• Incision is extended if a facelift is performed at the same time.
• Entire flap is advanced toward the back of the head and the excess trimmed to close without tension.
• The incision in the scalp skin is closed with sutures, and staples are used in the hair-bearing region.
• A light pressure dressing is applied.

After the procedure

• Painkillers may be given if necessary.
• Follow-up:
  • The wound is examined on the first postoperative day.
  • Stitches are removed on the fifth postoperative day.
  • Staples may be removed on the 10th postoperative day.

Though rare, complications can occur. Contact your surgeon, if you encounter any of the following complications:

• Blood clot (hematoma) formation
• Swelling
• Infection
• Facial nerve impairment
• Sensory nerve impairment: numbness around the incision tends to resolve in 3 to 6 months
• Loss of hair (alopecia): Alopecia may be temporary or permanent.
• Inability to close the eyelids completely
• Unsightly scarring
• Contour irregularities