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Brow Lift San Francisco

The anatomic changes that occur in the upper face associated with aging include; the descent or drooping down of the eyebrows over the orbital rim, hooding of eyelid skin over the lid shelf (where eye shadow is worn) and increasing wrinkles – horizontally oriented associated with the individual contracting the muscles that lift the eyebrows and vertical lines between the eyebrows – the result of making a frowning expression.

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 effect on making one look tired, angry and/or frustrated. The brow and upper face provide very important 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 skin 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.

The historical use of the term brow lift in San Francisco accurately described some of the early techniques used to treat the gravity 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 is able to achieve much more than just lift the brow, but shaping the brow and reversing the signs of aging. These techniques are classified and defined as follows:

1. Direct Brow Lift:

A carefully measured elliptical (banana) shaped section of skin is removed with within and along the very upper hairs of the eyebrow. This technique is very effective reducing the drooping or ptosis of the eyebrow and can be done with local anesthesia in office. The resultant scar, however carefully closed, is visible as a fine white line at the upper border of the eyebrow. This scar, for many patients, is not acceptable.

2. Mid Forehead brow lift:

This technique employs a carefully designed skin excision placed in one of the deep lines located 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 in my opinion, 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.

3. 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 scalp and forehead soft tissues are carefully elevated and the strong muscles (corrugators) that are commonly treated with BOTOX Cosmetic® 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 scalp is removed with a closure using surgical clips or sutures. For patients with a high hairline this technique is not often employed, 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.

4. Pretrichial or Trichophytic brow lift:

This technique employs a “wavy” incision along and into the hairline that allows hair to grow back through the scar thus disguising the scar. 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 that have 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.

5. Endoscopic Brow Lift:

This modern technique employs sophisticated telescopic camera technology to allow elevation of sagging brow tissues with much smaller incisions. Typically, 3 – 5 small incisions are made behind the hairline, 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, 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 healing process occurs and is absorbed over time by the body. Dr. Maas has published an article on Bioglue™ in the medical literature which is available on our website under the publications tab.

6. 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 that I have had many patients and some doctors report, is that treating ABOVE the eyebrows with BOTOX Cosmetic® or Dysport® can somehow lift the brow. This is counterintuitive as BOTOX Cosmetic® or Dysport® relax muscles. Therefore, in order to lift the brow we want to relax the muscles that are BELOW the eyebrow, as they are responsible for pulling the eyebrows down when squinting or frowning. A non- surgical brow lift thus provides two benefits – reduces wrinkles and elevates the eyebrows.

Can a Brow Lift be combined be combined with other San Francisco plastic surgery procedures?

A Brow Lift is often combined with a Upper and or Lower Blepharoplasty in San Francisco, or a Facelift in San Francisco, to achieve a natural look.

“My recommendations are to ask the following questions while having a consultation with a San Francisco plastic surgeon.” Dr. Maas

  1. How many brow lift surgeries have you performed in the last month as the surgeon in charge or primary surgeon?
  2. How many brow lifts have you performed in the last year as the surgeon in charge or primary surgeon?
  3. Are you Board certified by the American Board of Facial Plastic and Reconstructive Surgery or the American Board of Plastic Surgery?
  4. Have you ever had a complication with a brow lift surgery? If the surgeon responds no – be suspicious while significant complications are quite rare, any surgeon having done enough facial procedures to be an expert will have experienced at least some complication and this should be discussed.
  5. What is the worst complication you have experienced with brow lift surgery and how did you manage this complication?
  6. Ask to speak with patients that have had a brow lift with the surgeon in the last month or two. They can give a first hand account of their experience and whether their expectations were met.
  7. Ask to see before and after pictures and make sure that the pictures are of patients that your consultation surgeon was the primary surgeon.
It is never too late, To be what you might have been.- George Eliot