One widely held misconception is that lowered brows are always a function of age. In fact, many times brows raise with age while young people can have low, full brows.
The upper eyelid and eyebrow are intimately intertwined. In its basic form a browlift repositions the forehead and raises the brows. Some people who seek a consultation for eyelid surgery learn that the improvement in appearance they desire may include a brow/forehead lift in place of, or in addition to, an eyelid lift. The upper eyelid and the brow are not mutually exclusive. Surgery on one can directly affect the shape, contour and function of the other. A low position of the eyebrow can contribute to, or worsen the appearance of heavy upper lids.
Both age and heredity can play a role in the shape and position of the brows and their relationship to the eyelids. Descended brows can make for a worried, tired or sad look. By elevating and tightening the eyebrows and forehead skin, a more youthful, soft, alert expression is created. As a byproduct, forehead lines improve and creases may be lessened.
One of the most obvious yet critical priorities is to make certain you are a good candidate both aesthetically and anatomically for this procedure. Who may be a marginal candidate? Those with high hairlines or very thin hair coverage with visible scalp near the hairline are not optimal candidates. The key to a successful browlift is a conservative surgical and aesthetic approach to avoid an over-corrected appearance. This is especially important for men. Men should have lower brows than women—even after a browlift—or they risk looking feminine. Whether man or woman, a flat deflated brow pulled up over the bone, or an unaesthetic shape creating an inverted “V” in the upper face will negatively change one’s expression rather than enhance the appearance.
The brow is an interesting challenge. The overall aesthetics of the peri-orbital area must be carefully deliberated along with considering a person’s features at a younger age. This does not translate into creating a 30 year old brow on someone of 60 years, but rather taking into account where the brow originally was and how one has aged over time. Examining a person’s unique brow position and shape as well as the aging process through photographs demonstrates how the appearance has changed and helps in planning. The goal is not to recreate the same brow but use history as a guide for what will look great at one’s present age.
My approach focuses on employing techniques to create a soft, youthful appearance with optimum brow shape and position.
There are surgical and non-surgical approaches that can be considered depending upon the condition of the brow and a patient’s expectations.
There are two different approaches to surgical correction—the open coronal technique and the endoscopic technique. I advocate using the endoscopic technique.
An endoscopic brow lift is considered minimally invasive where 3-5 small incisions are made near the mid brow, temple and hairline. In this approach the arch and tail of the brow are elevated. The lifted position is maintained using absorbable material which absorb once healing occurs. The medial brow is elevated only if necessary. Inadvertently lifting the medial brow results in an unnatural, sad and surprised look. A thoughtful aesthetic and surgical plan encompasses only what needs to be released and lifted in a controlled manner. Surgical brow lift is often accompanied by volume correction and neuromodulators to decrease the muscle action on the brow which acts to increase longevity of the lift.
Masculine brows typically get looser and rotate over the bone with age. While it is more challenging due to a man’s higher hair lines and hair loss patterns, male brow lifts can be successfully done. Browlifts are done directly over the brow at the edge, or through one of the forehead lines. Injections in and around the brow, in men to replenish lost volume and lift three dimensionally, is an evolving technique that holds much promise.
Nonsurgical brow lifting can be quite effective in the right person. It may include one or a combination of the following:
- A neurotoxin such as Botox, Dysport or Xeomin applied to the upper facial muscles in a prescribed pattern
- Ultherapy is a micro focused ultrasound therapy that has FDA approval for brow lifting
- Fillers can achieve a mild three dimensional lift in deflated brows
Anesthesia: Sedation or general
Length of surgery: 1 1/2 hours
Adjunct procedures: Upper and lower eyelid lift, neurotoxins, fillers
Recovery: one week. (Numbness of forehead can persist longer)