blepharoplasty guide


Insider's Guide to
Blepharoplasty



Chapter 16

Eyebrow Surgery 

 

Other names: Brow lift, forehead lift, coronal lift, endoscopic brow lift, direct brow lift, temporal lift, midforehead lift, internal brow lift, browplasty, browpexy, upper face lift

Primary goal: Elevation of drooping eyebrows

Secondary goals: Softening of forehead wrinkling and glabellar (the area between the brows) frown lines

Special anatomy: Be sure to review the full-color illustration of the muscles of the eyelids, brow, forehead, and glabellar region (the area between the two brows).

Anesthesia: The more extensive the surgical approach, the deeper the level of required anesthesia. General anesthesia or deep intravenous sedation is advisable for coronal forehead lifts.

Operative technique: Because so many very different operations exist, presenting the specifics of each is beyond the scope of this summary. Depending upon the operation, the actual lift may be achieved by a combination of skin and muscle removal, tucking of underlying muscle, or loosening of forehead and scalp periosteum with resuspension at a higher level. Incisions may be closed by using simple sutures, staples, bone screws, or sutures placed through bone tunnels.

Variations: The number of different surgical approaches to brow elevation is large and include:

Coronal forehead lift, in which the scalp is incised from ear to ear over the top of the head

Endoscopic forehead lift, in which the forehead is loosened and elevated through small incisions in the scalp using of instrument called an "endoscope"

Temporal lift, in which the incision is made over the temple and only the outer portion of the brow is lifted

Midforehead lift, in which the incision is placed within a deep wrinkle on the middle of the forehead

Direct brow lift, in which the incision is made just above the eyebrow hair

Internal brow lift, in which the brow is stabilized through the upper blepharoplasty incision (see photo links below)

Non-incisional RF heating, in which radiofrequency energy applied to the skin of the forehead and temple supposedly tighten the deeper tissues

Cable brow lift, in which thick suture placed deep below the skin mechanically connects the eyebrow to tissues below the scalp to create a suspension

Limitations: See "Comments" below. For endoscopic brow lifting, the ideal candidate is a woman with thick hair, a low hairline, normal or thin skin, and slight brow droop; patients with thicker skin or more advanced drooping are generally better served with a full coronal forehead lift. Radiofrequency and cable brow lifts are relatively new and associated with high failure rates. Severe brow descent is difficult to address successfully with any procedure other than a direct brow lift.

Care and recovery: Bruising, swelling, and pain are more pronounced than with blepharoplasty, especially with the more invasive variations of the operation. Recovery is usually rapid, especially with endoscopic-assisted surgery skillfully performed.

Risks and complications: Aside from aesthetic concerns, the most common complication is objectionable scarring. When surgery is performed from within the hairline, the scars are hidden but may still become depressed or be associated with hair loss. When the incisions are made in visible skin, the scars are noticeable, slow to fade, and not always well hidden by natural creases. Only the internal brow lift (browplasty, browpexy) creates no additional scar (but is, unfortunately, a weak procedure that works only over the lateral brow and doesn't hold up well with time). Other less common complications include nerve damage, hematoma (large blood clot), asymmetry, excessive bruising and swelling, numbness, and scalp itching. If combined with upper eyelid blepharoplasty, the risk of lagophthalmos (inability to close eyes fully) is increased. Contrary to popular opinion, a recent survey conducted by the American Society of Plastic Surgeons found that the complication rates of the open coronal method and closed endoscopic method were comparable, while the coronal lift method was generally believed to be more efficacious and long-lasting.

Comments:

A brow or forehead lift (coronal or endoscopic) is an upper face lift and not an eyelid operation. Some cosmetic surgeons embrace the operation with a passion (which should alert a patient to be on guard), while others recommend it only cautiously. The reason for restraint is simple: a forehead lift changes the overall layout of your face and can make you look . . .well, different.

For the majority of patients in whom brow lift surgery has been recommended, taking the time to examine an old photo taken during their twenties may prove very informative. Why? Because in many cases it will show that the brow has not dropped. Most children and young adults do NOT sport high brows.

Unless you've developed facial paralysis or substantial forehead droop from advanced aging or smoking, lifting your forehead and brows alters the natural look of your eyes and face and can make you look like somebody you never were, even during those years when you were a high-school knockout. If your brows are obviously uneven and the asymmetry is objectionable or makes you look as if you're scowling, lifting the forehead may be a great idea. But, if you are only forty years old and your surgeon surprises you by recommending a forehead lift instead of or in addition to a blepharoplasty, be sure you understand precisely why you need such additional invasive (and expensive) surgery and ask to view before-and-after photos. While the look commonly bestowed upon the face may be described as ranging from "amazement" to "glamorous" to "exotic," a more accurate designation in many cases is "surgical."

In other words, the result may look unnatural, and in a man the result may also appear feminine. Forehead/brow lift is, in our opinion, an over-recommended procedure (not an inherently bad operation when truly needed, but rather an operation that is simply too commonly performed).

If the brow is low to start, an overly-aggressive blepharoplasty may sometimes aggravate the problem. The incidence of this undesirable side effect can, however, be greatly diminished by (1) avoiding excessive removal of orbital fat and (2) performing an internal brow elevation from within the blepharoplasty incision.

In a patient with pre-existing upper eyelid hollowness from any cause, browlift should be undertaken with caution. More

For reasons such as these, forehead/brow lifting (endoscopic and coronal) has steadily decreased in popularity. According to the American Society of Plastic Surgeons, while the number of blepharoplasties increased 7% between years 2006 and 2007, the number of brow/forehead lifts decreased by 24%.


• Internal Brow Lift Surgery Photos:

Internal Brow Lift (Browpexy)
Thinning the Brow Fat Pad (Browplasty)

Next: Lower blepharoplasty options


  


eyelid surgery resource

© Copyright 2000-2014 Frank Meronk, Jr., M.D.
All Rights Reserved

Reproduction of content from this website is prohibited.

Disclaimer: Information, observations, and opinions are presented for general reference use only and do not constitute specific medical advice, diagnosis, or treatment. Base all decisions solely upon the recommendations of your own doctors. With each use of this website, you signify your review and full acceptance of our current Terms of Use.