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Drooping brows may be elevated by a number of methods, the most common of which include:
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• Internal Brow Lift: Working from within the upper blepharoplasty incision, the brow fat pad can be thinned and shaped after release from its check ligament and muscular depressors, thus allowing the brow to elevate naturally under its own power. In most cases, the use of internal sutures is unnecessary.
While the enhancement is moderate, such surgery is not nearly as invasive or costly as other approaches yet yields a natural-looking lift that is sufficient in most patients. Internal brow elevation creates no additional scars, no forehead nerve damage, no scalp hair loss, and will not leave the face looking surprised.
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• Direct Brow Elevation: A separate incision may be made above the hairline of the brow (or rarely across the mid-forehead) and a strip of skin and muscle excised. The deeper tissues are then supported as in browpexy. Although this operation can yield a vigorous lift, its main disadvantage is the creation of a noticeable external scar that is slow to fade, and so it is seldom used.
• Forehead Lift: The entire forehead may be elevated from a number of incisions hidden by the hair of the scalp. While the use of endoscopy has minimized some of the scarring associated with the more extensive open coronal approach, the primary cosmetic disadvantages of forehead lift are that
• it may leave the face with a slight (or very noticeable) look of inappropriate surprise
• the upper eyelid may become pulled up and replace the pupil as the focus of attention
• the overly-exposed eyelid may appear hollow in a way that makes the face look older (adequate lid fullness is a sign of youth) and the eye look smaller, and
• the effect (as with any sort of 'lift' designed to fight gravity) may be rather short-lived.
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A brow or forehead lift (in reality, an upper face lift) does not substitute for an eyelid lift, and vice versa. Each operation is directed at a different problem and achieves a different outcome. When indicated by the patient's condition, the two procedures may sometimes be performed simultaneously.
Unless there is clear evidence that the forehead has actually drooped, however, conservatism is wise when considering a lift. The highly arched and elevated brow so popular during the 1950s (then a product of eyebrow plucking and pencil) is now not only considered a dated look but also a give-away that one has undergone cosmetic surgery. Today's stylish young adults do not sport highly elevated brows (examine the models in any fashion magazine or a photo of yourself at age twenty).
When indicated, a forehead lift can be an excellent procedure to combat the effect of true upper FACE descent, but it is does not duplicate the improvement obtained from a well-done upper eyelid lift, or blepharoplasty.
Anesthesia > Upper Lids > Brows > Lower Lids
Insider's Guide to Blepharoplasty
Chapter 16: Eyebrow Surgery
The Hollowed Eyelid
Brow lift and hollowed upper eyelid
The Eyelid Owner's Manual
Internal Brow Lift (Browpexy) - Step-By-Step Photos
Trimming the Sub-Brow Fat Pad (Browplasty) - Step-By-Step Photos
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