A Modified Nonendoscopic Subperiosteal Brow Lift Via Transblepharoplasty Incision

Purpose: To evaluate a minimally invasive transblepharoplasty subperiosteal suture-suspended brow lift that was developed by the senior investigator (N.A.N.) to restore the brow complex in the setting of visually significant brow ptosis. Methods: A retrospective review was performed of all patients who underwent this procedure by a single surgeon (N.A.N.) from 2008 to 2022. The primary outcome measure was the change in margin-reflex distance 1 (MRD1) and brow-reflex distance (BRD), measured from the pupillary reflex to the first row of brow cilia. Results: A total of 32 patients (61 eyes) were included, with an average age of 68% and 53% were female. Brow ptosis in 3 patients was unilateral due to unresolved Bell’s Palsy. The average follow-up was 76 days. Statistical analysis of bilateral cases revealed post-operative brow elevation (mean right BRD +2.82 mm [ P < .001] and left BRD +2.42 mm [ P < .001]) and upper eyelid elevation (mean right MRD1 +1.99 mm [ P < .001] and left MRD1 +1.71 [ P < .001]). Brow ptosis recurred in 3 patients bilaterally, and there were no long-term complications. Conclusions: This surgical technique is an effective and safe minimally invasive option for patients with brow ptosis. It completed under light sedation without the need for endoscopic equipment.