Restoring Youthful Vitality

These changes become more profound with age as the skin loses its elasticity and the effects of gravity and facial expression take their toll. More than just aging, the effects described have a marked impact on making one look tired, angry, or frustrated. The brow and upper face provide significant social clues as to the well-being of an individual. It is important to remember that the same loss of skin elasticity of the forehead profoundly affects the eyelid skin, causing creepiness and skin hooding independent of the eyebrows' descent. This eyelid condition is often referred to as dermatochalasis and is treated either with or without browplasty and with eyelid surgery, known as blepharoplasty.

Brow Lift Techniques

The historical use of the term brow lift in San Francisco accurately describes some of the early techniques used to treat the gravity-dependent and age-dependent drooping of the eyebrows and hooding skin of the eyelid. The more appropriate modern term is browplasty. With a comprehensive approach to the aging brow, one can achieve much more than just lifting the brow; one can shape the brow and reverse the signs of aging. These techniques are classified and defined as follows:

Brow Lift Surgery Before & After

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Direct Brow Lift

A carefully measured elliptical (banana) shaped section of skin is removed within and along the upper hairs of the eyebrow. This technique effectively reduces the drooping or ptosis of the eyebrow and can be performed with local anesthesia in-office at The Maas Clinic™ of San Francisco. However, when carefully closed, the resultant scar is visible as a fine white line at the upper border of the eyebrow. This scar, for many patients, is not acceptable.

Mid-Forehead Brow Lift

This technique employs a carefully designed skin excision placed in one deep line above the eyebrows. The optimal design places the incisions over each eyebrow at different levels. This discontinuity makes the resultant scars much more difficult to identify once the wound has adequate time to heal. A mid-forehead brow lift (forehead lift) generally provides a more cosmetically favorable outcome but is used in most cases in our practice for men with deep forehead lines. The endoscopic brow lift has mostly replaced this technique, even for men.

Coronal Brow Lift

This technique, which has gained a resurgence in popularity in recent times, employs an ear-to-ear incision over the top of the head. For obvious reasons, balding men are not considered good candidates for this approach. The soft tissues of the scalp and forehead are carefully elevated, and the strong muscles (corrugators), commonly treated with BOTOX® or Dysport, are cut. This muscle function is strictly limited to making frowns and pulling the eyebrows down. The scalp tissues are then elevated to appropriate levels, and a swath of the scalp is removed with a closure using surgical clips or sutures. This technique is only sometimes employed for patients with a high hairline, as it is expected to raise the hairline by up to several centimeters. Many patients experience permanent scalp anesthesia (loss of sensation) and or parenthesis (tingling and discomfort) with this approach. However, the incision is well hidden behind the hairline.

Pretrichial (or Trichophytic) Brow Lift

This technique employs a "wavy" incision along and into the hairline, allowing hair to grow back through the scar, thus disguising it. Patients with higher hairlines are ideal candidates for this approach as the hairline position is preserved. This technique is also used for hairline lowering. Hairline lowering is an excellent option for patients with a very high forehead (representing more than one-third of the face when viewed from the front) and can be combined with browplasty/lifting or done as an independent procedure. San Francisco plastic surgeon Dr. Maas has employed this technique to correct hairlines that have been "over-elevated" with previous coronal brow lift surgery.

Endoscopic Brow Lift

This modern technique employs sophisticated telescopic camera technology to allow the elevation of sagging brow tissues with much smaller incisions. Typically, 3 to 5 small incisions are made behind the hairline, the elevation of the sagging tissues is achieved, frown muscles are truncated, and the brow is repositioned. The repositioned brow is held in place by one of several "fixation" techniques. Most commonly, small partial holes are drilled into the "outer cortex" of the skull bone, and small absorbable devices are secured in these bone dimples and the overlying and repositioned soft tissues. Over time, these small "plates" dissolve, providing good long-term brow position. Alternatively, my preference is to avoid drilling the skull bone and instead use an FDA-approved biologic glue commonly employed in heart surgery. Bioglue has provided good results for us in securing brow position while the body absorbs the healing process over time. Dr. Maas has published an article on Bioglue™ in the medical literature, available on our website under the publications tab.

Non-Surgical Brow Lift

First described in the medical literature by Dr. Maas and one of his fellows, neuromodulators such as BOTOX Cosmetic or Dysport can be very effective in lifting the brow, particularly in younger patients. One common misconception many patients and some doctors report is that treating above the eyebrows with BOTOX Cosmetic or Dysport can somehow lift the brow, but this is counterintuitive, as BOTOX Cosmetic or Dysport relax muscles. Therefore, we want to relax the muscles below the eyebrow to lift the brow, as they are responsible for pulling the eyebrows down when squinting or frowning. A non-surgical brow lift thus provides two benefits–it reduces wrinkles and elevates the eyebrows.

Woman with short hair

Can a Brow Lift be Combined with Other Plastic Surgery Procedures?

A brow lift, or forehead lift, is often combined with an upper or lower blepharoplasty (eyelid surgery) or a facelift to achieve a natural look. Corey S. Maas, MD, of The Maas Clinic™ in San Francisco, reviewed the information about brow lift surgery. If you have any questions, don't hesitate to contact us now.

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