Commentary

There is already precedent for using direct incisions in the eyebrow area to improve the contour or elevation of the brow. Traditionally, the suprabrow excision has been a helpful technique for these purposes, but it has also been fraught with certain difficulties in terms of scar visibility following after surgery.

I have performed adjacent suprabrow excisions for many years and have had at least 90% excellent patient acceptance because of the technique I employ, which has worked well for me. When making the incision, if approximately 1 mm is trimmed from the border of the eyebrow hair and the incision is made adjacent to the remaining hairs, the scar is usually at the hair-bearing area and heals very well. If the scar is 1 mm or more above the eyebrow edge, the scar is potentially unacceptable.

In the author's technique, a subbrow incision is made to reduce excess skin and improve the contour of the upper Asian eyelid. If the same guidelines are followed, with placement of the scar into the lower border of the brow hairs, the resulting incision will probably be very good. It will likely require at least six to eight months of follow-up postsurgery in order to see how well the scars will heal, simply because either slight misplacement of the scars or keloid/hypertropic scar formation might become evident at this time.

In general, the author's technique seems good and can likely be used in cases other than just Asian eyelids (for example, in patients with crepe skin above the area visually excised during blepharoplasty). I can think of several patients of mine who might have benefitted from this type of skin elevation and resection.

The number of people who “qualify” for this procedure is narrowed by the indications; patients are limited to “those who had dermatochalasis of the upper eyelids with lateral hooding (and who wish to revise the eyebrow contour) and/or tattoo or who cannot tolerate a lengthy lateral upper eyelid scar.” This procedure is also indicated in cases in which a surgeon is narrowing a tattooed eyebrow that is too wide and can be excised on the inferior part of that tattoo.

It is helpful to know that this incision can give a good result with regard to the scar and the surgeon's ability to lift the lateral eyelid skin. Obviously, there are a very limited number of patients in whom this would be helpful, but it is always nice to have one more option with which to accomplish minor changes when needed.