This procedure is particularly suitable for male patients with thick bushy eyebrows and receding hairlines (thereby masking brow scarring and avoiding coronal scarring), patients requiring a less extensive procedure and those with unilateral brow ptosis secondary to facial nerve palsy.
The extent of tissue excision is marked with the patient sitting upright aiming to position the scar within the upper row of brow hairs. The lower skin incision is made with the scalpel blade bevelled such that the incision is parallel to the hair shafts. This obviates transverse sectioning of the hair follicles thus minimising brow hair loss. Skin and subcutaneous tissue, with underlying orbicularis muscle as necessary, are excised taking care to identify and therefore avoid damage to the supraorbital neurovascular bundle. If surgery is undertaken for seventh nerve palsy then tissue excision down to the periosteum with deep fixation of brow tissue to periosteum using interrupted 4/0 Prolene sutures is necessary. The deeper tissues are closed with 4/0 or 5/0 Vicryl taking care to evert the skin edges prior to skin closure using a subcuticular 5/0 Prolene suture which is removed after five to seven days. This layered skin closure approach facilitates a thin flat scar.
Complications including loss of brow hair and/or an unsightly scar may result from poor surgical technique. An unacceptable brow position or contour is usually due to inappropriate marking. Permanent forehead parasthesia may occur with supraorbital nerve damage.
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