Mid-forehead buttonhole eyebrow elevation

The aging forehead and brow are an important aspect of facial rejuvenation. While there are many techniques in brow rejuvenation, both nonsurgical and surgical, there is no consensus on an optimal technique. With advances in technology, endoscopic brow lifts initially became very popular at the expense of open techniques. With longer term patient follow-up, dissatisfaction with predictability and longevity of results has caused resurgence in the open approaches. The Mid-Forehead Buttonhole Technique was developed for more accurate eyebrow elevation with better reliability than endoscopic techniques with less morbidity and recovery than more traditional open techniques. The incision is made over the lateral aspect of the brow and placed within a horizontal skin crease. Subcutaneous undermining allows access to the orbicularis oculi muscle. This is elevated with a modified purse-string suture which is secured to the frontal bone periosteum. An ellipse of skin is usually excised concurrently. The incision is meticulously closed to minimize any visible scarring.