A brow lift is not about creating high eye brows. Often only upper eye shape is the goal. A brow lift, also called a forehead lift, is a cosmetic surgery procedure that elevates or tightens the soft tissue and skin of the forehead and brow. The brow lift smooths lines in the forehead and rejuvenates the brow area, which may have become heavy looking, creating a tired, unhappy or angry look. It is especially effective in rejuvenating the upper eyelids. Many patients undergo a brow lift alone to treat perceived upper eyelid sagging.
Both men and women can benefit from brow lifts. A man typically has a heavier brow than a woman, but as a woman’s brow begins to droop, her brow becomes more masculine. How so? The “shelf” on the outer half of the brow, where the skin drapes the bone, makes the eye feminine and youthful. As the brow droops, this shelf disappears.
It is often necessary to combine brow lifts with facelifts in order to create balanced, complete results. The better the facelift result, the greater the need for a combined brow lift to both balance the lower face and neck result and ensure the transition from the lifted repositioned lower face, so that it does not bunch or pleat as it meets the sagging, unlifted forehead.
It is common that people do not perceive their forehead aging changes as they notice jowl or a lax neck. The reason is that we have an unconscious reflex that does not let our eyebrows to become noticeably low in many people. This would cause limitations in our upward vision so our brain uses our forehead muscles to silently activate, lift our brows but creates the furrows instead. This is why Botox® has become popular to treat our forehead furrows.
Unfortunately, if the forehead has been affected by gravity changes and is truly sagging, Botox® injections will paralyze the forehead muscles causing the brow/forehead to fall and make our eyes appear worse.
If our lower faces have drooped and fallen enough for someone to need a lower facelift, their forehead has been affected similarly. Since the signs of a loose forehead can be around the eyes or hidden in furrows, prospective patients are not always aware that the upper face has been affected significantly by aging and unbalanced procedures will reveal noticeable discrepancies from the rejuvenated to the untreated area. In addition, bunching and pleating around the eyes is a hallmark of an imbalanced procedure, since folds are not naturally occurring in this area of the face. In circumstances in which a brow lift is not combined with a facelift it can be necessary to limit the result in the lower face and neck to avoid imbalances and disharmonies. The worse the neck or nasolabial folds, the greater the need for a combined facelift and brow lift.
Since older facelift techniques did not reposition the drooping soft tissue as effectively as deep-plane facelifts do today, brow lifts were not always combined with facelifts as better facelifts necessitate today.
There are a few types of brow lifts. The decision between which specific type is based on individual facial characteristics such as hair type and hairline position.
Coronal Brow Lift
A classic but older procedure, the incisions made for this lift is hidden in the hair and can extend from almost ear to ear. The forehead is tightened by removing excess tissue utilizing the strong deep layer in the forehead. No tension is placed on the skin. This lift offers better control of the brow position and a more long-lasting effect. Numbness will be present for about nine months behind the incision on the top of the head. Muscles between the eyebrows can also be treated.
Combined Coronal/Endoscopic Brow Lift
Created by Dr. Gordon as an advancement of both coronal and endoscopic brow lifting, significantly shorter incisions similar in placement to those used with a coronal brow lift are made and endoscopes and instruments are used to complete the procedure. Similar lifting and between-eyebrow muscle work is accomplished. This produces consistently, natural brow lifts because the tension from the lift is distributed equally across the entire length of incision instead of being made at only a few points, a limitation of the standard endoscopic procedure. Since tissue is removed, this lift is longer lasting. Similar to coronal or endoscopic lifts, it will raise the hairline and also produce numbness behind it.
Thread or Suture Brow Lift
Threads or sutures can also be used to lift the brow. This is a ‘short cut’ procedure that places all tension of lifting on a few widely spaced sutures or threads. It has a high potential for creating unnatural results and can produce pain syndromes and does not produce a long lasting outcome.
Pretrichial Brow Lift (Hairline)
As men and women age, their hairlines recede. Given this fact, it’s important to note that this is the only brow lift that lowers, not raises, a forehead hairline. The incision precisely follows the front hairline, weaving in the first few hairs. Great care is taken to bevel or angle the incision, which allows hair to grow through the healing incision line. The incision is unapparent quickly and this technique gives the surgeon the most control over the brow position. As is the case with the coronal brow lift, numbness will be present behind the incision line for about nine months. Similarly, muscles can be treated between the eyebrows. Because of its ability to lower someone’s hairline this is the most common brow lift and creates a fuller look to one’s hair.
Temporal Brow Lift
A temporal brow lift, also known as a lateral brow lift, lifts the drooping skin of the outer brow line. It does not lift the mid-forehead or allow work to be done on the midbrow furrowing muscles. It can be used to help avoid the pleating of a sophisticated facelift in a person who cannot have a full brow lift, such as bald men. The incisions from a temporal brow lift will be inconspicuous, however, this lift might not hold up as long as other brow lifts. It is often used to ‘touch up’ a previous brow lift.