Gull Wing Midforehead Lift

Abstract

In case of both medial and lateral brow ptosis in a balding candidate with a furrowed forehead, one may consider a midforehead lift, a technique that has not gained much popularity because of concerns regarding clearly visible scarring. We have applied this technique in a selected group of patients and wish to share our experience discussed among a review of the English-language literature. Our series of 10 male patients (average age, 56.9; operated in period between 2003 and 2006) were contacted, asked to return for a follow-up, and interviewed; all data were collected, including the excised amount of tissue and postoperative complications. Patient satisfaction was assessed (Likert scale) as well as the objective aesthetic result using the Strasser scoring system. Eyebrow position increased significantly (P < 0.035) after surgery, and remained stable over the follow-up period of 3 years. Postoperatively, the majority of the patients (7 of 10) was satisfied with the result and would repeat surgery based on their experience (average visual analog scale score, 7; range, 4-8). In all cases, functional complaints had decreased significantly. Although most patients reported to be somewhat bothered with the initial aesthetical aspect of the scar, only 1 of 10 patients was not satisfied with the overall aesthetic result. Four patients were graded as good, 3 patients as mediocre, and 1 patient as poor as based upon the Strasser grading system. These results demonstrate that there is a limited but definite indication for the gull wing midforehead lift in cases of generalized ptosis of the forehead in balding males with high and furrowed foreheads.

Midforehead Lift for Brow Ptosis Caused by Bilateral Facial Nerve Palsy

“…Direct brow lifts are most commonly used for asymmetrical brow ptosis caused by unilateral facial nerve palsy 8) . However, for cases with medial brow and glabellar ptosis, as in our patient, direct brow lifts do not sufficiently lift the medial brow and glabellar areas, and visual field disturbance is not improved 6) . Additionally, while the pretrichial and coronal lift provide the benefit of no visible scarring, there may be undercorrection in patients with a heavy forehead (skin and subcutaneous tissue) and/or severe brow ptosis 9) .…”

“…Approaches to brow lifts include direct brow lift with excision of skin directly above the brow 5) , midforehead lift with excision of skin between furrows 6,7) , and pretrichial and coronal lift with excision of skin either in front of or beyond the hairline 8,9) . Direct brow lifts are most commonly used for asymmetrical brow ptosis caused by unilateral facial nerve palsy 8) .…”

“…In our patient with bilateral severe brow ptosis, we therefore used a midforehead lift, which allows for transverse skin excision and more selective control of the brow position in comparison to other techniques. This midforehead lift has previously been used in cosmetic surgery 6) , but this is the first report of its use for brow ptosis caused by bilateral facial nerve palsy.…”

Long-Term Evaluation of Endoscopic and Pretrichial Open Forehead Lifts: A Morphometric Analysis

“…1 For that reason, various methods of eyebrow elevation have been developed and described: on the one hand, there are so-called open procedures (including the direct eyebrow lift, the midforehead lift, the Fogli lift, the pretrichial coronal lift, and the posttrichial coronal lift); on the other hand, there are closed procedures (endoscopic forehead lift and thread lifts). 3 In the late 1990s, the endoscopic forehead lift largely replaced the open procedures and became the procedure of choice for many facial plastic surgeons. 4 Thereafter, a significant drop arose in the popularity of this procedure for various reasons.…”