As we age, it seems that every part of the face descends, and the eyebrows are no exception. When the brows are low, they can create a worried, tired, or angry appearance, and can even block vision. To correct these problems, patients are usually best served with brow lift surgery. In general, there are five surgical techniques that a surgeon can use. This article will summarize these approaches, and the advantages and disadvantages of each.
1. Direct Brow Lift. The most direct way to raise the brows is to remove an ellipse of forehead skin directly above the eyebrow. This called a “direct” brow lift, and by closing the wound, the brow is lifted.
Advantages:
- Since the surgical site is so close to the brow, it is easy to lift the brow by a precise, planned amount.
- If the forehead is large and the hairline is high, this approach does not make the hairline even higher. In fact, the forehead height is reduced by removing forehead skin.
- The procedure is simple, quick, and can even be done under minimal anesthesia.
Disadvantage:
- A scar is created that is on a very visible part of the face. With the best closing technique, the scar will be a very thin, faint white line, but may still be visible. So, this technique is best for patients with deep skin wrinkles on the forehead. This way, the scar can be hidden in an existing wrinkle. Alternatively, the scar can be positioned at the upper edge of the eyebrow, so the hairs of the eyebrow can hide it.
2. Pre-trichial Brow Lift. This is similar to a direct brow lift, except the ellipse of excised skin is removed at the hairline. The cuts are made so hairs actually grow through the thin scar.
Advantages:
- Like the direct lift, there is good precision with a pre-trichial lift.
- The scar is hidden by the hairline, because hairs actually grow through it.
- The position of the hairline does not change.
Disadvantage:
- The surgical technique is more complicated and difficult. The angle of the incisions must be exact, and hair follicles cannot be damaged.
3. Coronal Brow Lift. With this approach, a long, thin strip of scalp is removed across the entire top of the head. The forehead and scalp skin that are between the strip and the brows are then elevated to provide easy movement, and pulled vertically to lift the brows.
Advantages:
- The scar is long, but it is completely hidden by hair on top of the head. Of course, if a patient is bald or at risk of losing hair, then this approach may not be indicated.
- This approach provides the greatest lift of the brows, so is good for patients with severe descent of the brows.
Disadvantages:
- This is the most “invasive” approach, and has the highest chance of causing numbness of the forehead and scalp. Recovery is also fairly long.
- Future hair loss will reveal the scar.
- The hairline is raised along with the brows, which is a problem for patients with pre-existing high hairlines.
4. Temporal Brow Lift. This procedure involves incisions in the scalp of the temples. Each is about 4 cm. long, and positioned about 2 cm. behind the temple hairline. A wedge of scalp is removed at each side, and the lateral brows are then elevated during the closing.
Advantages:
- Like the coronal lift, the scars of a temporal lift are hidden completely by hair.
- There is no risk of numbness to the forehead and scalp.
Disadvantage:
- This technique only provides a lift of the lateral brows. It does not change the position of the medial brows.
5. Endoscopic Brow Lift. This is the “state-of-the-art” brow lift technique, and uses some advanced technology. Here, four or five very small (2 cm.) incisions are made in the scalp: one incision in each temple region, and the remaining incisions on top of the head. A magnifying television camera on a long, thin, metal wand is then inserted into each incision as needed. Through other incisions, specialized tools are used to elevate the skin of the forehead and brows. The skin and brows are then lifted vertically and secured into a higher position.
Advantages:
- A very effective lift can be achieved, and can be tailored somewhat to focus on lifting the medial and/or lateral brows.
- By using the magnifying camera, the nerves of the forehead can be protected more easily. So, there is a reduced risk of numbness compared to a coronal lift.
- The scars are very short and hidden by hair. The technique can even be used by some patients at risk for hair loss.
- Recovery is relatively easy.
- The hairline is raised slightly, but not dramatically.
Disadvantages:
- Though the endoscopic lift is effective, there is a limited potential for lifting compared with the coronal technique. So, for patients with severe brow descent, this technique may not be sufficient.
- Specialized equipment and training are required.
Both Drs. Kabaker and Hicks perform the first 4. Endoscopic brow lifts are only performed by Dr. Hicks, who has extensive training and experience in this technique. During your consultation, you can learn more about these techniques, and which may be best for you.
