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Alan J. Fisher, Browpexy, Aesthetic Surgery Journal, Volume 25, Issue 1, January 2005, Page 54, https://doi.org/10.1016/j.asj.2005.01.006
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Extract
To the Editor:
In his article on browpexy, Dr. Harvey Zarem1 describes a technique to “support the lateral brow and enhance the sulcus” through an upper lid blepharoplasty approach whereby the arcus marginalis is sutured to the superior edge of the incised orbicularis oculi muscle.
The article claims that this technique will deal with the ptotic brow or “at least fix it at the level of the supraorbital rim.” Most standard techniques of brow fixation address the issue of brow ptosis by elevating the frontalis and galeal attachments of the brow to a more superior, or higher, level after incision of the arcus marginalis. Suturing the thin orbicularis muscle to the arcus marginalis does not appear to address the problem of the superior rotation vector needed for brow elevation. In addition, the sulcus created by suturing the superior edge of the orbicularis oculi to the arcus marginalis creates, in my opinion, a high, unnatural crease that is most often associated with aging. A high, skeletonized upper lid crease is precisely the look most patients seeking eyelid rejuvenation wish to avoid. Finally, it is essential to address the preoperative problem of eyelid ptosis, which may be more obvious after skin excision.
