Board Certifications: American Board of Facial Plastic and
Reconstructive Surgery American Board of Otolaryngology - ABO

Procedures :: Surgical


The pretrechial and trycophytic incision are mainly used in patients who have a high forehead or in patients who want to retain the pre-operative hair implant line. During the pretrechial lift, an incision is made and performed at the junction of the hair implant line and the cephalic boarder of the eyebrow. The trycophytic incision involves is located immediately posterior to the frontal hair implant line. Both incisions must be chamfered to avoid damage to the hair follicles. Some surgeons prefer to use an irregular line of incision in order to camouflage the incision, whilst others prefer to make use of straight-line incision, which is technically easier to execute.

The pretrechial lift can be performed on the subcutaneous, subperiosteal or subgaleal level, in a manner that is similar to the coronal lift. The subcutaneous lifting of the eyebrows provides a much better procedure in relation to the patient with severe wrinkling on the forehead and marked ptosis of the eyebrows. The coetaneous flaps are loosened resulting in excellent removal of the wrinkles on the forehead. Also, there is continued sensory irritation, to a large extent, without interruptions, consequently avoiding hypostasis of the scalp. This requires a meticulous dissection with a relatively higher risk of hemorrhaging of the scalp. The subcutaneous procedure should be avoided in smokers. In addition, great care must be taken to ensure a pressure-free closure. This will reduce the risk of necrosis of the skin occurring.


The endoscopic lift of the eyebrows was described for the first time in 1992, by Vasconez and Isse,3 and thereafter published by Vasconez, in 1994, 12. This is an excellent procedure for the patient with a forehead of average height and slight to moderate ptosis of the eyebrows. Although this technique has been around for a long time, it has still not completely replaced the open techniques.13 The contraindications include serious ptosis of the eyebrows, a high frontal implant line and thick and sebaceous skin. The advantages of the endoscopy technique is that it involves small incisions, speedy post operative recovery, reduced risk of there being hair loss and a decrease in diminished post-operative sensitivity. The technique requires specialized training and equipment.

Normally, four or five incisions are made. The fifth incision or the incision along the midline is employed in a patient with a deep nasal root, prominent frontal ridge or orbital border and/or the need for greater medial traction. This incision is often required for male patient who has long eyebrows. The incisions are generally 1 to 1,5cm long and the paramedian incisions are made about 1,5cm posterior to the hair implant line. They are positioned in accordance with the desired traction vector. Incisions are made with a scalpel until the bone is reached, and a separator is used to lift the eyebrow from a subperiosteal aspect by using the non-dominant hand for guidance above the supraorbital boarder. Elevation takes place from the vertex, 1,5cm above the supraorbital rim and, laterally, until the temporal line.

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