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Brow Lift  -  Forehead Lift

 

                              Brow Life or Forehead Lift Surgery

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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.

 

 

 

 

Aging of the forehead can cause ptosis:

  • Forehead

  • Brow

  • Glabellar

  • Temple

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.

 


 

 

Indications for Brow Lift Surgery:

  • Drooping eyebrows causing a visual field problem.  

  • Fatigue and headaches at the end of the day because of using the forehead muscles which raise the eyebrows too much.

  • Aesthetic or cosmetic reasons.

 

 

 

 

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.

 

 

 

 

Information about Brow Lift Surgery:

  • 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).

 

 

                               Anatomy of Forehead or Brow Muscles

 

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Functions of the Muscles:

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.

 

                                     Orbicularis Occuli Muscle

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Anatomy of the Facial and Neck Muscles
 

 

 

 

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:

  • eyelid muscle weakness

  • dry eye

  • excess tearing

  • double vision

 

 

 

The most common techniques used for brow lifts are:

 

 

      Brow Lift Incision Sites - Three Most Common Incisions:  Coronal Forehead Lift - Endoscopic Forehead Lift - Subcutaneous Forehead Lift

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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.

Read more about the Coronal Brow Lift 

 

 

 

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.

Read more about the Endoscopic Brow Lift

 

 

 

Temporal Brow Lifts elevates the tail of the brow and is primarily reserved for female patients desiring a more feminine arched brow.

Read more about the Temporal Brow Lift

 

 

 

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.

Read more about the Pretrichial and Trichial Brow Lifts

 

 

 

DIRECT BROW LIFT

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

Read more about the Direct Brow Lifts

 

 

 

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.

Read more about the Feather Lift - Suspension Lift

 

 

 

 

 

 

Other Brow Lift Links:

 

 


 

 

 

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