Definition and Anatomy
The forehead and brow are important components of a younger face. The position of the brow can influence the appearance of the eyes and eyelids. A youthful eye is one that appears “open” and is free of wrinkles. A sagging brow can make the eyes look “tired” and can contribute to the formation of droopy upper eyelid skin. The actual position of the brow varies widely between individuals. Some people have naturally high set brows and others have their brows very close to the upper eyelid margin. However, everyone shares the same enemy of youth – gravity. Even those with naturally high brows can have gradual descent over time due to gravitational effects, causing droopy upper eyelid skin. The forehead contains muscles that work to elevate the brow. As we age, the constant contraction that occurs from facial expression causes horizontal wrinkles to become visible in the central forehead. Also, the “frown lines” in between the eyebrows become more apparent. These forehead wrinkles can also be even more accentuated if there are sagging brows from gravity. This may not be very intuitive, but as the brows sag, we sub-consciously try to elevate the brows and relieve the upper eyelid skin by contracting the forehead muscles, and thus creating more forehead wrinkles.
How to Treat
Brow-lifting (or forehead lifting) is a surgical procedure that not only re-positions the brow higher (if sagging), but also allows treatment of the forehead wrinkles and frown lines. It can be done through two main approaches: open or endoscopic, both of which are effective. The “open” approach involves an incision all the way across the top of the scalp, but is thought to provide the best longevity of the result. In this technique, the muscles that cause the forehead and frown wrinkles are divided directly from underneath. Also, a rim of scalp tissue is excised to allow for brow elevation. In the endoscopic technique, the incisions are smaller (usually three incisions) and utilizes a small camera through these small incisions to achieve the same goals. Scalp is usually not excised, but rather suspended upward. This technique avoids long incisions but sometimes the results are not as long-lasting. Both techniques do not completely remove the capability of facial expression. The muscles that are inactivated are only in the central forehead, and not in the lateral brow. Depending on the degree of brow descent and the “heaviness” of the brow/forehead (males tend to have heavier tissues), some patients may be a better candidate for one versus the other technique.
Who’s Eligible for Browlifts
The typical browlift candidates are those in their 40’s and older who have the beginning signs of brow descent and deeper forehead/frown wrinkles. They may complain of a progressively “tired” appearance of their eyes, but they may not exactly know why. These are often patients who have had Botox treatments in their 20’s and 30’s to help eliminate those finer wrinkles. Older patients may have so much extra upper eyelid skin, that it is obscuring their vision. These patients will often have very deep forehead wrinkles because of the constant sub-conscious contraction of the muscles to elevate the brow and the relieve the over-hanging upper eyelid skin.
The goal of a brow-lift is not just elevation, but also, to rejuvenate and to re-shape the forehead and the upper eyelids. This procedure works well in combination with upper eyelid surgery to correct the “tired” eye appearance, because just removing extra skin of the upper eyelid is frequently not enough.
Brow lift Procedure Recovery
A browlift typically lasts 1 to 2 hours, and because it is commonly performed with other facial rejuvenation procedures, an overnight stay is recommended. Recovery lasts approximately 1 to 2 weeks and bruising and swelling resolves during this time period (if there is any). A dressing is worn for a couple of days in order to minimize swelling and to prevent fluid collections. Sutures and/or staples in the scalp are removed after 1 week. Numbness in the forehead and scalp is common and can last up to 6 months before mostly resolving.