Adjunctive Procedures in Upper Eyelid Blepharoplasty: Internal Brow Fat Sculpting and Elevation, Glabellar Myectomy, and Lacrimal Gland Repositioning

Abstract

There are a number of adjunctive procedures to upper lid blepharoplasty that can be performed via the upper eyelid blepharoplasty incision at the same setting to improve eyelid appearance, brow position and contour, and reduce glabellar rhytids. These include internal brow sculpting and elevation, glabellar myectomy, and lacrimal gland repositioning. Eyebrow ptosis is an important and frequent finding in facial plastic surgery patients, commonly coexisting with dermatochalasis and blepharoptosis. Blepharoplasty and eyelid ptosis repair performed alone, in the presence of significant brow ptosis, can result in further lowering of brow position with negative functional and cosmetic consequences. Internal brow sculpting and elevation, while not as effective as other forms of formal eyebrow lifting, is a convenient way to elevate/stabilize a ptotic brow without the need for additional incisions. Glabellar myectomy is another adjuvant procedure that can be performed through the same upper eyelid incision. The procedure removes the medial brow depressors, allowing the frontalis muscle to more effectively elevate the medial and central brow. In addition, the procedure effectively reduces dynamic vertical glabellar rhytids and dramatically improves the migraine and the tension type headaches that originate in this area. Finally, repositioning a prolapsed lacrimal gland by resecuring it to the lacrimal gland fossa is also a useful procedure that can be performed at the time of blepharoplasty via the same incision. It effectively reduces the temporal fullness present in patients with a dislocated lacrimal gland.