The Upper Third: Framing the Face The forehead region and eyebrows are the “framing” of the face. Well-positioned eyebrows convey youth, alertness and expressiveness. Ptotic (droopy) eyebrows create a tired, sad or angry appearance — even when the person isn’t. Frontoplasty (or browlift) is the surgery that corrects brow ptosis, elevating the eyebrows to a youthful position. Historically, it was performed through a coronal incision (ear-to-ear) or, more recently, endoscopically. The Modern Face technique proposes a third way: frontoplasty via temporal access with subperiosteal dissection. This approach eliminates the need for expensive endoscopic equipment while maintaining excellent results and integrating perfectly with [Endomidface.
“The upper third is often neglected in facelift. However, rejuvenating mid-face and neck while keeping ptotic eyebrows creates disharmony. Frontoplasty completes rejuvenation.”
- — Dr. Robério Brandão
Relevant Anatomy
Ideal Eyebrow Position
The “ideal” eyebrow position varies by gender and individual characteristics:
👨 Male
- • Position at orbital rim level
- • Straighter/horizontal shape
- • Subtle or absent peak
👩 Female
- • Position above orbital rim
- • Arched shape
- • Peak in lateral third
Critical Structures
Frontal (Temporal) Branch of Facial Nerve
Innervates frontalis muscle. Injury causes inability to raise eyebrow. Crosses zygomatic arch in temporoparietal fascia.
Supraorbital and Supratrochlear Nerves
Provide forehead sensation. Emerge from orbital rim. Injury causes frontal anesthesia.
Temporal Fusion Line
Where superficial temporal fascia fuses with periosteum. Crucial landmark for safe dissection.
Frontoplasty Techniques: Comparison ✓ Advantages: ✗ Limitations: )) }
Modern Face Technique: Step by Step
💡 Integration with Endomidface
Modern Face frontoplasty uses the SAME temporal access as Endomidface. When combined, a single access allows rejuvenation of upper third (eyebrows) and middle (malar) simultaneously. 1
Markings
Mark current and desired eyebrow position. Identify supraorbital foramen. Plan temporal incision (same as Endomidface if combined). 2
Temporal Access
Incision in temporal scalp. Dissection through temporoparietal fascia until identifying deep temporal fascia (shiny white plane). 3
Zygomatic Arch Release
Subperiosteal dissection over zygomatic arch. Protects frontal branch of facial nerve which is superficial at this point. 4
Frontal Dissection
Subperiosteal extension to frontal region. Direct visualization of structures. Release up to near orbital rim. 5
Rim Release
Careful release of attachments at orbital rim. Preserve supraorbital nerve. This step allows adequate mobilization. 6
Elevation and Fixation
Elevate eyebrow to desired position. Fixation with sutures in deep temporal fascia (vertical vector). Verify symmetry. 7
Closure
Scalp closure. Compressive dressing. If combined with Endomidface, dressing is joint.
Indications and Contraindications
Indications
- ✓ Brow ptosis (droopy eyebrow)
- ✓ Excess eyelid skin due to brow ptosis
- ✓ Tired/sad appearance due to eyebrow position
- ✓ Deep forehead wrinkles
- ✓ Eyebrow asymmetry
- ✓ Desire for upper third rejuvenation
Contraindications
- ✗ Very high hairline (consider coronal)
- ✗ Advanced frontal alopecia
- ✗ Expectation of exaggerated elevation
- ✗ True eyelid ptosis (requires blepharoplasty)
- ✗ General contraindications for surgery
Frequently Asked Questions
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Related Articles
Endomidface Guide
Learn how browlift integrates with midface rejuvenation.
Nerve Protection
Anatomy and safety protocols for the temporal region.
Combined Eyelid Surgery
How blepharoplasty and browlift work together.
For surgeons: Master the temporal access technique in our [advanced surgical mentorships.
Learn Frontoplasty in Practice
The Legacy Combo includes frontoplasty techniques integrated with Endomidface and Deep Neck.
View Mentorship Programs