Background: Brow lifting became a component of the facialplasty procedure 45 years ago, and the original brow-lifting technique incorporating a coronal incision approach is still practiced by many surgeons today. Over the past 15 years, however, the endoscope-assisted procedure and the limited incision, nonendoscopic techniques have evolved as alternate procedures for brow lifting. The level of artistry in performing any brow lift technique is raised when the surgeon acquires knowledge of upper facial anatomy and integrates that knowledge into a working concept of the aging process of the upper face.
Methods: This article presents one surgeon’s concepts of the process that culminate in the typical appearance of the aged upper face. The same understanding of upper facial anatomy that can be called upon to explain the steps in this aging process can also be applied to the technical steps of any foreheadplasty procedure. Those anatomic structures that play a role in this process are examined here.
Results: The typical appearance of the aged upper face is the product of muscle action and gravitational forces acting on the unique anatomy of the human face. Interestingly, the appearance of the typical aged upper face exhibits much the same characteristics as one might observe in the face of an individual experiencing the emotions of sadness or grief. It is an inappropriate facial expression of sadness or grief that most often motivates the patient to schedule a consultation with the plastic surgeon.
Conclusion: Any of the brow lift procedures used in current clinical practice can provide a successful cosmetic result in selected patients if the procedure incorporates technical steps based on sound anatomic principles.