Brow Lifts

Posted Thursday, September 13, 2007 to PROCEDURES > Face

Posted by The Original Anti-Aging & Cosmetic Surgery Magazine

What type of lift is right for you? Often a brow lift is all the facial surgery you need to turn back to clock. Anita Catalano reports.

Do you look in the mirror and grimace at the reflection? Is the face you see tired, wrinkled and worn out? Most people think the only way to rejuvenate a tired looking and aging appearance is a facelift. But often all that's needed is a browlift to restore a youthful countenance.

As we age the effect of gravity takes its toll on our appearance and our eyebrows droop. This can give both men and women an angry or sad look.

Some people think that means it's time for a face lift while others believe eyelid surgery is the answer. But many don't realize that often it's their sagging eyebrows that are the cause of the problem.

Atlanta facial plastic surgeon, Morton Slutsky MD, said sagging eyebrows can change a person's appearance.

"The brow sags and stretches and creates a hound dog look, and at the same time people can get hooding of the upper eyelids," he said.

A browlift corrects the sagging position of eyebrows and can improve the worried or angry expression that can result from frown lines.

Atlanta facial plastiC surgeon, Brian Maloney MD, likened the eyebrows to a frame around a painting.

"I look at the eyes like a picture and the eyebrow is the frame on that picture," he said. "When the brow settles over time the eyes become smaller and with an elevation or brow lift the eyes can be refreshed."

But sometimes surgeons can get it wrong and give patients that awful startled look. "A lot of surgeons overdo the eyebrows and we see a lot of startled looks," Dr Maloney said. "And we find that as a result, a lot of people back off when we talk about a browlift. The aesthetics of the proper position of the eyebrows is important for both surgeons and patients to understand."

Historically surgeons would usually perform an upper eyelid lift to correct sagging skin on the upper lid. But more often today, a browlift is used to create the same result.

There are a number of different brow lift techniques available. The choice of technique depends on a number of factors, which include the position of the eyebrows, amount of excess upper eyelid skin, height of the hairline, and whether they have a high or low forehead. Atlanta facial plastic surgeon, William Silver MD, said surgeons study the entire face before they make a decision on which technique is suitable. "It's important to analyze every part of the face and each factor is taken into consideration before I make a recommendation."

Patients with a low forehead

Endoscopic browlift

Many surgeons like to use this technique on patients with low foreheads as it allows them to raise the hairline.

This technique, which is gaining popularity, involves making three to five tiny incisions in the scalp. A small endoscope, or long thin tube with a light on the end, is attached to a tiny video camera and inserted into one of the incisions. This allows the surgeon to see the muscles and tissues underneath. In a separate incision, the surgeon inserts another instrument which allows him to lift the forehead and position the eyebrows. An important benefit of an endoscopic browlift is that it results in minimal scarring.

"I look at the height of the forehead and if a patient has a low to average forehead we often do an endoscopic approach with minimal incision," Dr Maloney said. "It utilizes a telescope allowing us to project the anatomy on a television screen giving us a good view of the area."

Coronal browlift

A coronal brow lift was one of the most popular techniques before the introduction of the endoscopic browlift.

The coronal, which also suits patients with low or average foreheads, involves the surgeon making an incision from one ear to the top of the head and around to the other ear.The incision, which is made about four centimeters behind the hairline, allows the surgeon to lift the skin of the forehead and realign the muscles and remove any excess fat or skin. Dr Maloney said many patients didn't like this method because of the scar.

Patients with a high forehead

Direct Skin Browlift

A high forehead can give the impression of an aged look despite the eyebrows being in a good position. Patients with a high forehead may be suited to a trichophytic, pretrichial or direct browlift as these procedures don't lengthen the forehead. The direct skin browlift involves a piece of skin being removed adjacent to the eyebrow then closed. This procedure helps to reshape the eyebrows.

Pretrichia and Trichophytic lifts

This involves an incision that begins in the hairline just above the ears and sweeps forward either just in front or just inside the hairline along the front of the forehead. The trichophytic incision is beveled sharply in the central forehead to allow hair to grow back through the incision. Patients who experience high forehead surgery generally experience numbness for around six months.

Will it hurt?

Like any surgery, patients will experience some discomfort, and in more extreme cases complications. Dr Silver said most patients undergoing forehead lifts usually have a quick and fairly easy recovery.

Scars: Over time scars fade or are covered by new hair growth.

Bruising: Swelling and bruising will usually subside a few weeks after surgery. The swelling is usually more prominent around the cheeks and eyes. Some surgeons offer lymphatic massage or focus on anti-bruising medication and skin care creams.

Numbness: Most patients who have a coronal browlift will experience numbness on the top of the scalp. Patients receiving an endoscopic browlift experience minimal numbness. The numbness in both cases is usually transient.

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