March24, 2023

Abstract Volume: 6 Issue: 1 ISSN:

Techniques and Approaches in Brow Lifting for Lateral Eye Rejuvenation – Innovative Classification

Ibrahim A. Ashary, MD *

Corresponding Author: Ibrahim A. Ashary, MD, Consultant plastic surgeon.

Copy Right: © 2022 Ibrahim A. Ashary, MD, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received Date: September 16, 2022

Published Date: October 01, 2022



The ultimate rejuvenation objective of cosmetic brow lifting is to achieve an aesthetic balance and rejuvenation of the periocular area. Patients seeking cosmetic surgery are focused with achieving their ideal appearance. As a result, it is vital that cosmetic surgeons evaluate the significance of approaches that are most effective in reaching patients' cosmetic goals. In addition to advising patients about potential results and any challenges that may arise as a result of the planned surgery. Aging of the face usually shows in the mid-face especially the eyes, for the eyes are the most part of the face where fat decent and laxity of the skin is most visible. Surgeons and patients for the brow lifting procedure has a common goal, it is to rejuvenate the area in the least possible downtime. Because of this, several techniques were developed in order to achieve this goal.

Non-surgical brow lift techniques are only temporary, and none of them are totally satisfactory due to their limited effectiveness, lack of longevity, and possible repercussions. However, Ashary thread-brow lift and Ashary surgical brow lift are one of the few techniques that were develop to increase satisfactory rate in patients and longevity of the results.

Techniques and Approaches in Brow Lifting for Lateral Eye Rejuvenation – Innovative Classification


Although each operation is tailored to the patient's specific senile alterations, the majority of patients seeking brow lifting have a component of brow ptosis with or without asymmetry.[1] As a result, an oculo-facial plastic surgeon must be familiar with surgical anatomy, stage identification of aponeurotic ptosis, and procedures for brow rejuvenation. In contrast to upper and lower blepharoplasty, which has a standard technique that has been adopted and used practically uniformly, eyebrow surgery has a wide range of surgical options. These procedures can be paired with upper blepharoplasty to achieve stable, long-lasting, and natural results. Recognizing each patient's unique characteristics and pairing them to the best rejuvenation procedures will provide the most aesthetic improvement.

Important (external) signs of periorbital aging:[2]

The appearance of "black" under-eye circles, creases under the lower eyelids; The appearance of crow's feet.

Lower eyelid falling, pseudohernial sacs, and brow and upper eyelid descent appearance of a fatty hernia appearance of a festoon.

The lacrimal, palpebromalar, and palpebrobuccal grooves are visualized.

Suborbital atrophy and displacement.

Resorption and deformation of bone orbital structures.

As a result, when the complicated approach and combined exposure are applied to all the layers and structures vulnerable to age involution, the most gratifying outcome of utilizing injection correction procedures in the periorbital area can be attained.

Non-invasive treatments have grown in popularity in recent years because to their relative simplicity and short recuperation time.[3]

The appropriate algorithm of combined complementary techniques (botulinum therapy, contour and volumetric face plasty using fillers, mesotherapy, thread-lifting) and adherence to all necessary precautions, as well as agent administration guidelines, will result in significant aesthetic improvement of the patient's appearance. The combination of minimally invasive methods of correction allows for the supplementation and improvement of plastic surgery outcomes, as well as the postponement of surgery for an extended period.


Material and Method

In this case report, we have investigated the effect of Ashary thread-brow lift and Ashary surgical brow lift in female patients with challenging cases of four different classes of periorbital aging.

There are two types of Ashary brow lifts: thread lifting (minimally invasive); these are temporary, need less experience, and can be readily reversed if a complication arises. Surgical techniques, on the other hand, include those with a transient impact (suture lift and trans-blepharoplasty procedures) and some with a more permanent effect (direct and trans-forehead approaches). Surgical techniques are often more dependent on the surgeon and the equipment, and complications are more sophisticated.



According to I.I. Kolgunenko's (1974) classification, the weary morph type of age-related alterations, which is the most physiological type of aging, includes changes mostly focused in the middle third of the face, including the periorbital area.[4] These alterations include the production of grooves (tear trough, palpebromalar groove, nasojugal groove) (Figure 1), dark under-eye circles, the formation of mimic wrinkles, fat compartment displacement, a change in mimic muscle tone, ligamentous structure stretching, and upper eyelid overhang.

The combination of these symptoms relates to age-related changes, even in young patients, and is related to a subject's constitutional traits. T. Hestler and F. Nahai established the most complete classification of age-related alterations happening simultaneously in all anatomical layers (muscles, fatty tissue, skin, ligamentous apparatus) in the periorbital and neighboring areas (buccal, frontal, brow). Importantly, the essential characteristics of age-related alterations in the periorbital area are seldom detected individually, frequently occur in far younger people, and grow more apparent over time.[5]

Ashary Brow Lift Technique are divided in to two categories: surgical minimally invasive and surgical invasive. Brow lifting with threads is considered minimally invasive because of the size of incision done and the amount of time spent in procedure. Thread lifting with pre canulated needle is one of the easiest, least invasive approach in lifting the brows. While surgical brow lifting is invasive, the duration of the result is incomparable with any other approach.’



Patients who received treatment based on the classification which ensures proper diagnosis of the periorbital aging stage and grade, Magnificent improvements of the Brow Descent, drooping eyelid, lower lid laxity, increased vertical eyelid length, nasojugal groove, malar bag and tear trough were observed following the procedure of Ashary thread-brow lift and Ashary surgical brow lift.



Ashary thread-brow lift and Ashary surgical brow lift have proven to be one of the few techniques that were develop to increase satisfactory rate in patients and longevity of the results even after one year of follow up.

The proper diagnosis using the classification suggested is a fundamental path for the choice of material and technique to be used to increase the success rate of the treatment.

Recommendations: we recommend the application of the classification in table.1 in the diagnosis and treatment selection.



1. Karimi N, Kashkouli MB, Sianati H, Khademi B. Techniques of eyebrow lifting: a narrative review. Journal of ophthalmic & vision research. 2020 Apr;15(2):218.

2. Hirmand H. Anatomy and nonsurgical correction of the tear trough deformity. Plastic and reconstructive surgery. 2010 Feb 1;125(2):699-708.

3. Koch RJ. Non-Invasive Cosmetic Procedures. PMPH-USA; 2012.

4. Viktorovna KG. Journal of Clinical Review & Case Reports.

5. Hirmand H, Codner MA, McCord CD, Hester Jr TR, Nahai F. Prominent eye: operative management in lower lid and midfacial rejuvenation and the morphologic classification system. Plastic and reconstructive surgery. 2002 Aug 1;110(2):620-8.

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