Eyebrow Lift: Open-Book ROOF Transposition and Orbicularis–Frontalis Sliding Maneuver

Abstract

This article delves into innovative surgical techniques, the open-book ROOF (retro-orbicularis oculi fat) transposition technique (OBRoof) and the orbicularis–frontalis sliding maneuver (OFS), designed for eyebrow and upper eyelid rejuvenation in the aging process. Emphasis is placed on understanding the dynamic changes occurring within the forehead and eyebrow envelope's five layers and their intrinsic relationships as well as the impact of the ROOF ptosis causing upper eyelid hooding. The OBRoof technique is highlighted for its effectiveness in addressing ptotic volume, offering a rejuvenated appearance by relocating volume to the supraciliary region.

In the OFS, we explore the concept of extensive dissection above the upper border of the eyebrow to allow for free repositioning of the eyebrow. The stabilization is based on deep-plane facelift concepts, as the orbicularis oculi muscle corresponds to the superficial muscular aponeurotic system, and it is anchored to the deep layers (periosteum) by passing through the frontal muscle.

In summary, this article provides a comprehensive exploration of innovative and minimally invasive techniques for eyebrow and upper eyelid rejuvenation, shedding light on their anatomical foundations, procedural intricacies, and the potential for achieving natural and lasting outcomes.

Keywords

eyebrow lift - ROOF lift - blepharoplasty - browpexy - oculoplastics

Publication History

Article published online:
23 April 2024

• References

• 1 Costin BR, Plesec TP, Sakolsatayadorn N, Rubinstein TJ, McBride JM, Perry JD. Anatomy and histology of the frontalis muscle. Ophthal Plast Reconstr Surg 2015; 31 (01) 66-72
• 2 Knize DM. An anatomically based study of the mechanism of eyebrow ptosis. Plast Reconstr Surg 1996; 97 (07) 1321-1333
• 3 Lemke BN, Stasior OG. The anatomy of eyebrow ptosis. Arch Ophthalmol 1982; 100 (06) 981-986
• 4 Ridgway JM, Larrabee WF. Anatomy for blepharoplasty and brow-lift. Facial Plast Surg 2010; 26 (03) 177-185
• 5 Bernstein L, Nelson RH. Surgical anatomy of the extraparotid distribution of the facial nerve. Arch Otolaryngol 1984; 110 (03) 177-183
• 6 Ko AC, Korn BS, Kikkawa DO. The aging face. Surv Ophthalmol 2017; 62 (02) 190-202
• 7 Hoenig JA. Comprehensive management of eyebrow and forehead ptosis. Otolaryngol Clin North Am 2005; 38 (05) 947-984
• 8 Alex JC. Aesthetic considerations in the elevation of the eyebrow. Facial Plast Surg 2004; 20 (03) 193-198
• 9 Paul MD. The evolution of the brow lift in aesthetic plastic surgery. Plast Reconstr Surg 2001; 108 (05) 1409-1424
• 10 Mancini R. Nonsurgical considerations for addressing periocular aesthetics: a conceptual dimensional approach. JAMA Facial Plast Surg 2014; 16 (06) 451-456
• 11 Vrcek I, Chou E, Somogyi M, Shore JW. Volumization of the brow at the time of blepharoplasty: treating the eyebrow fat pad as an independent unit. Ophthal Plast Reconstr Surg 2018; 34 (03) 209-212
• 12 Cohen BD, Reiffel AJ, Spinelli HM. Browpexy through the upper lid (BUL): a new technique of lifting the brow with a standard blepharoplasty incision. Aesthet Surg J 2011; 31 (02) 163-169
• 13 Armstrong BK, Sobti D, Mancini R. Partial orbicularis resection for the augmentation of traditional internal brow pexy: the “tuck and rise”. Ophthal Plast Reconstr Surg 2016; 32 (06) 473-476
• 14 McCord CD, Doxanas MT. Browplasty and browpexy: an adjunct to blepharoplasty. Plast Reconstr Surg 1990; 86 (02) 248-254
• 15 Duarte AF, Pereira A, Delgado JA, Devoto M. Internal eyebrow lift. In: Burnstine MA, Dresner SC, Samimi DB, Merritt HA. eds. Ophthalmic Plastic Surgery of the Upper Face. 1st ed. Thieme; 2019