There are several established methods for performing an eyebrow (also called a forehead) lift. The oldest method is called a coronal brow lift. This form of a brow lift is done by making a very large incision behind the hairline from one side of the head to the other. The forehead and brow are lifted accordingly and the incision is sutured closed. The most important advantage to this form of a brow lift is the fact that the brow can be raised a significant amount by simply removing more and more skin. However, this form of a brow lift also has several very large disadvantages. The surgery is much more expensive than other forms of a brow lift. Also, there is a very large scar hidden behind the hairline in those with abundant hair. Those who do not have thick hair do not hide the incision well. Also, there can be permanent numbness in the scalp region after this form of surgery, as some of the sensory nerves are cut by the surgical technique.
Other forms of a brow lift or forehead lift are performed without making such a large incision. One such form of a brow lift is an endoscopic brow lift. This is done by making several small incisions behind the hairline and using a small camera inserted through one of the incisions, the forehead is lifted to a higher point. The advantage of this form of a brow lift is that there is no single large incision. However, the incisions still can be visible if the patient does not have a full head of hair. The technique employs various methods of keeping the forehead in a higher position once it has been lifted through the small incisions. One of these methods is a suturing method that holds the brow and forehead up higher. The other employs a device called an Endotine, which is a fixation device made of a dissolvable material that holds the brow and forehead in its higher position for three to six months before dissolving. The forehead and brow form natural attachments over this period of time that keep the brow in the new higher position.
Another method of raising the brows is to do what is called a transblepharoplasty brow lift. This is a method of raising the eyebrows through the upper eyelid incision that is made for a blepharoplasty. Since brow lifts and blepharoplasties are usually performed together, sometimes this means that the brow can be elevated without an additional incision. With this method of a brow lift, the brow and forehead are addressed from the eyelid incisions. They are lifted and raised to a higher position. Just as in the endoscopic forehead lift, the brow and forehead need to be fixated in the new higher position and this can be accomplished either with sutures or with the device called the Endotine. The advantage of this form of a brow lift is that the incisions are minimal. This allows for much faster healing and essentially no visible scars. The disadvantage of this technique is that the eyebrow and forehead may not be able to be elevated as high as with the other forms of a brow lift.
In many patients the tail of the brow will descend to a more significant degree than other portions of the eyebrow. There are many patients in which Dr. Ebroon would advise raising the tail of the brow much more than the central portion of the brow or the portion closest to the nose. Raising the tail is helpful because it can give the effects of a brow lift without giving the surprised look that no patient is interested in. The tail of the brow can be lifted with any of the methods outlined above. Usually, after consulting with the patient, your physician might recommend a transblepharoplasty assisted brow lift, perhaps with a single incision in the temple region, to achieve the desired brow position.
Brow lifts are an important part of eyelid and upper face rejuvenation. A subtle brow lift can add a tremendous amount to the effects of an upper eyelid blepharoplasty. It can enhance the rejuvenating effects of an upper eyelid blepharoplasty and is therefore a very popular procedure.
Some patients prefer to raise the brows non-surgically. This can be done to a small degree with the use of Botox. Botox is a medicine that temporarily relaxes muscles, usually for a period of three months. It is a very popular method to reduce wrinkles between the eyebrows, in the forehead, and in the crow’s feet areas. Botox can also be used in the tail of the brow to raise the tail of the brow minimally. It has this effect because there are muscles near the eyebrows that both raise the tail of the eyebrow (the frontalis muscle) and muscles that depress the tail of the brow or bring the tail of the brow down (the orbicularis muscle). If Botox is skillfully placed into the orbicularis muscle in the area in which it brings the eyebrow down, this muscle will temporarily be weakened and the muscle that raises the tail of the brow will work unopposed and perform a nonsurgical temporary minimal brow lift.
Depending on an individual’s personal anatomy and their personal feelings about surgery, the appropriate method can be employed to enhance the brow position and thereby enhance appearance.