For a younger smoother brow, a brow lift done
alone or in combination with a facelift or other facial procedures including
blepharoplasty (eyelid surgery). A youthful, feminine brow rests above the
level of the orbital rim, which is the upper margin of the bony socket in which
the eye resides. Sometimes skin and soft tissue will lose elasticity with age
and sun exposure causing the lateral brow to descent to a level below the
orbital rim. This produces a tired or an angry looking appearance. Compared to the female brow - a man's brow is aesthetically acceptable at the
orbital rim or slightly below.
A brow lift can offer two key outcomes:
First, it can act like a form of permanent BOTOX
by releasing or removing the muscles that causes unsightly crease in the brow.
However, even with significant removal of the corrugator muscles, those that are
active in the "furrows" - there could be a return of function over time and
creasing could begin again. Aggressive and imprecise removal of the corragator muscles can cause contour deformities visible on the skin surface. If this should occur, these problems can be successfully treated with BOTOX.
Second, a brow lift can smooth the wrinkles of
the forehead and if necessary, correct a low or hooded brow by raising it to a
more naturally alert position. Unfortunately some women as they age, can
appear "angry looking" due to a heavy or furrowed brow. This can end up
making the nicest person appear stern or tired. The elevated muscles may
be secured with undetectable permanent sutures,
tiny titanium tacks or an internal device
that holds soft tissue.
The effects of a brow lift are permanent although
you and the rest of your face will continue to age. Brow lifts or
forehead lifts are now gathering a lot of attention with helping patients who
have had chronic headaches - as a brow lift prevents these muscles from
constricting.
A brow lift is commonly referred to as a
"forehead lift" or a "eyebrow lift", is a procedure designed to elevate the brow
to a more youthful position relative to the eyelids.
The three areas of concern with a brow lift
are the following:
With a brow lift, the muscles and the tissues
that contribute to the furrowing or to the drooping of the eye area are either
removed or alters to smooth the forehead - raise the eyebrows and minimize frown
lines. In general, a brow lift involves a relatively short recovery
process and most patients do not experience much pain or discomfort.
A droopy eyebrow is referred to as brow ptosis
and often coexists with
dermatochalasis and ptosis or
lateral eye hooding.
Brow ptosis is repaired with a
brow lift, which can be performed in a number of different ways. Brow ptosis can
contribute to eyelid ptosis.
Correction of glabellar ptosis
improves skin laxity and
glabellar wrinkles - and correction of
temporal ptosis improves
Crow's feet.
Commonly called "brow droop" - this can cause
significant overhang of upper eyelid skin over the lashes and interfere with the
visual function or appear unsightly. It is usually bilateral but can be
asymmetrical, appearing on one side.
As the brow sags due to the weight - this
directly causes
the eyelid skin and muscles and underlying structures to become weak
attachments. Ptosis surgery of the eyelid itself requires adjusting the
position of one of the two muscles which elevate the eyelid.
Eyebrow ptosis is caused by the following:
Aging - where the
muscles and tissues become lax with thinning - causing a descent of the
tissue of the forehead.
Eyebrow ptosis
can co-exist with the condition dermatochalasis
- which is true upper eyelid ptosis with excess skin on the upper eyelids.
Eyebrow ptosis
can be caused by a paralysis of the facial nerve - such as (facial palsy) or
a tumor or trauma on one side.
Sometimes asymmetry can be fixed with a brow lift
and other times it cannot. If one eye is more deeply set in the bone of
the eye or the "orbital socket". The deeper set eye will have more lax
tissue causing the upper eyelids to appear different.
There might also be contributing to asymmetry,
flattening of the cheekbone which is causing the one eye to appear different. Or, there may be an orbital dystopia (where the eye bones are actually at
different levels).
Brows can also be very different with their
strengths of muscle function to make the brow appear different. The entire
anatomy of the face comes into place when speaking about asymmetry.
No patient is completely symmetrical with their
face or brow, and a plastic surgeon or an occular plastic surgeon can help
tremendously with analyzing these issues - and give suggestions to the patient
with minimizing the different asymmetry.
Quit taking
aspirin and other anti-inflammatory medications for two weeks prior to
surgery. Discuss all of your prescription and non-prescription
medications with your surgeon.
If you have
mild to moderate brow droop and horizontal wrinkles - an endoscopic lift
may be the most appropriate method.
If you have a
high forehead and are unwilling to wear bangs or accept a hairline scar,
you probably should not have a brow lift.
Anticipate
that your forehead will appear higher after an endoscopic or coronal
lift than it did before surgery.
A forehead or
a brow lift will not improve baggy eyelids or crow's feet.
To minimize
swelling, sleep in a recliner or with your head elevated on pillows for
the first several days after surgery. Apply ice compresses
frequently.
The exact type of
brow lift that will be right for you will depend greatly on your own anatomy and
the degree of droopiness or sagging tissue. There are many muscles in the
forehead and upper face area, and although some brow lifts only rearrange or
remove some skin - there are many brow lifts that will rearrange or remove
muscle tissue. Most brow lifts include removing some tissue beneath the
skin of the forehead area and manipulating the muscles of the forehead to
achieve the desired appearance. By raising the eyebrows to create a your
youthful appearance, the forehead muscles and skin both need to be pulled
upward.
The forehead and
eyebrow regions have these major muscles
groups:
The muscular layer of
the eyebrow is below the subcutaneous tissue.
This layer is
composed of:
The elevator
muscle (frontalis)
The depressor
muscles (procerus, corrugator supercilii,
orbital portion of the orbicularis oculi).
The
frontalis is the major muscle of the forehead. This muscle runs straight down
from the scalp to the eyebrows and is responsible for moving the eyebrows. The
frontalis muscle is part of the complex of muscles called the occipitofrontalis.
The
corrugator muscle is located below the occipitofrontalis - this moves the inner
corner of the eyebrow. The
corrugator muscles produce vertical glabellar furrows.
The
procerus muscle arises from the
lower part of the nasal bone, and its action pulls down the medial end of the
eyebrow and produces horizontal wrinkles of the skin.
The orbicularis oculi muscles
circle the eyes and are located just under the skin. Parts of this muscle
act to open and close the eyelids and are important muscles in facial
expression.
Men and women who
are medically fit and healthy - but are bothered by a flattened brow or a
brow that contributes to unwanted sagging above the eye may be good
candidates for a brow lift. Most patients that are interested in a
brow lift are often looking to improve a tired, angry, sad or aged
appearance caused by unwanted heaviness in the upper eyelid and brow.
There are many
brow lift patients who inquire about upper and lower blepharoplasty or
eyelid surgery to correct the appearance they see with a flattened or
sagging brow. However, there are many patients who are given the
suggestion of a combination brow lift and eyelid surgery to correct the
underlying issues. A heavy or a drooping brow can contribute partially
or entirely to the overall cosmetic deformity along the upper eyelid region.
There are some
patients who have an excess of eyelid skin and also suffer from a heavy brow
- which contribute to impair peripheral vision. Many of these cases
are covered by medical insurance.
It is very
important that a brow lift patient or eyelid rejuvenation patient be
completely free of any problems occurring with the eye, such as:
Coronal Brow Lift is the oldest and most reliable
technique in brow lift surgery. The incision in a coronal brow lift
involves running across the top of the crown of the head from ear to ear.
This lift elevates the entire brow. Endoscopic brow lifts may be performed on patients who have a forehead area that
facilitate the use of the surgical telescopes and instruments easily.
Pretrichial and trichial brow lifts elevate the entire brow. This procedure is done using an open technique with a continuous
incision and the removal of a defined amount of forehead skin.
The
pretrichial brow lift, involves an incision made in front of the
hairline. This incision helps to elevate the brow while
also shortening a high forehead.
The
trichial brow lift does not shorten the forehead - but it does
elevate the brow through the removal of a defined amount of
forehead skin.
With
the direct brow lift an incision placed just above the eyebrow
area - which should be located in a well developed horizontal
crease. This type of brow lift is good for males, who are
bald and might not be a good candidate for the coronal,
endoscopic,
pretrichial or trichial brow lifts.
INDIRECT BROW LIFT
The indirect brow lift is similar
to the direct brow lift except the incision is made in a natural
forehead crease some distance above the eyebrow
Suspension lifts treat the first signs of sagging
by using specially designed sutures or threads to hold slightly slack skin in a
higher position. These procedures can raise the brows, soften sagging in
the mid-face and refine a drooping jowl.
