Objective Comparison of Eyebrow Position after Internal and External Browpexy

Several brow lift techniques have been used to prevent brow ptosis after blepharoplasty. For example, both internal and external browpexies have been adopted worldwide. However, few studies have compared these two methods. We compared postoperative eyebrow position changes between upper eyelid skin excision, internal, and external browpexy. We retrospectively reviewed the cases of 87 patients who underwent upper blepharoplasty performed by a single clinician at our institute between April 2018 and June 2020. Patients with routine outpatient photographs taken before and after surgery were enrolled in the study. Image J was used to measure brow height at eight points in each eye. Brow height changes were compared among the three groups. Routine photographs were available for 68 patients (133 eyes). Thirty-nine patients underwent internal browpexy (78 eyes), nine external browpexy (17 eyes), and 20 upper eyelid skin excisions (38 eyes). Three months after surgery, significant elevation was noted on the lateral side of the brow in the internal browpexy group and across the whole brow in the external browpexy group. In the upper eyelid skin excision group, whole brow ptosis was observed. Brow lift outcomes were better in the external than in the internal browpexy group, while both browpexy groups showed better outcomes than the upper eyelid skin excision group. Within 3 months of surgery, both internal and external browpexy provided significant brow lift effects, preventing brow ptosis due to blepharoplasty with skin excision. External browpexy had better brow-lift outcomes than did internal browpexy.