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Brow lift by flap transposition in the glabrous brow area.

In brow lift, if a direct approach is utilized, the suture line medially is placed in a normal frontalis crease, and then the lateral part of the suture line, by lateral transfer of a small superiorly based flap, is caused to fall into a natural "laugh line" or "crow's feet" crease, three improvements result: 1. Greater control and predictability of shaping and position than with other techniques; 2. A more normal appearance, including better lateral lift and a much more inconspicuous scar than with supraciliary direct lift; 3. A longer-lasting result. In approximately 150 patients, scar appearance has been very gratifying indeed, with only 3 limited segmental scar revisions and 2 secondary midforehead elliptical excisions. It is believed that the principle exhibited in the tightening of the upper suture line by flap transfer, referred to by analogy as the worm principle, accounts for much of the improvement, especially in durability. This principle is seen as an aid in thinking through the mechanics of several other plastic surgical situations as well.