Brow & Forehead


Understanding the Aging Eyebrow

Eyebrow and Forehead Lifting addresses eyebrow position and loose or wrinkled forehead skin and underlying tissue. To fully understand the benefits of eyebrow and forehead lifting, one must be aware of the importance of the position of the eyebrows.

Our natural eyebrow position changes as we age due to the effects of gravity, loss of tissue elasticity and tone, fat atrophy, and continuous eyebrow and forehead muscle use over time.

In our daily interactions, our face sends a message, and the position of the eyebrows is a significant part of that message. Patients often complain that they look “worried,” “angry,” “tired,” or “stressed” when they don’t feel that way. Their facial expression doesn’t present how they truly feel inside.

In addition to these unpleasant facial expressions, brow descent will lead to a “crowding” of the eyes by excess eyelid skin. The “hooding” of the eyes by the eyelid skin, in addition to the feeling of eyelid heaviness, will often lead to a subconscious drive to use your forehead muscles to counteract the drooping brow. Though this action will camouflage the brow droop, it will lead to development of forehead creases and lines that will deepen over time. A browlift or forehead lift, often in combination with fat grafting to restore volume, can significantly improve these facial features, and restore a person’s natural rested, rejuvenated appearance. Not only will the elevation of the brow lead to a more “open and alert” appearance to the eyes, it will also naturally diminish the development of the forehead lines that lead to a more aged appearance.

There are several types of eyebrow and forehead lifts. The type you and your surgeon choose will depend on your current eyebrow position, your hairline, facial structure, and on what is possible to maximize your appearance. The main types of forehead lifting are as follows:

The Pretrichial (Hairline) Brow/Forehead Lift

Though the Pretrichial Brow Lift requires a longer incision along the hairline, Dr. Amadi feels that this gives the most powerful and long lasting lift with an aesthetically “friendly” incision. This procedure is ideal for patients who want to lift the eyebrows while shortening the forehead by removing a strip of skin and underlying tissue along the incision. Because the forehead is shortened, the hairline is lowered which is ideal for those with a high forehead. This procedure lifts everything from the hairline down to the eyebrows and can address eyebrow shape and asymmetry. The scar from the incision, once healed, is virtually undetectable as the incision is made in such a way that hair follicles are preserved, allowing for hair growth through the scar. Following the procedure there will be some bruising and swelling. Patients usually return to their normal daily routine in 1-2 weeks.

A Coronal browlift is a similar type of surgery, except the incision is made on the crown of the head much further back in the hairline. Though this hides the incision well, it increases the height of the forehead which is usually not desired.

Endoscopic Brow/Forehead Lift

The Endoscopic Eyebrow/ Forehead Lift is very popular as it requires 5 small incisions hidden in the hair and leaves no visible scar. This procedure can lift everything from the hairline to the eyebrows. It tightens and smoothes the entire forehead while lifting the eyebrow area which “opens up” the entire upper face. Eyebrow shape and asymmetry can be addressed with this type of lift. This type of lift may not be ideal with someone with severe brow descent or heavy skin, and may not be as long lasting a lift as the pretrichial method. Following the procedure there will be some bruising and swelling. Patients are usually comfortable returning to their normal routine activities in about 1- 2 weeks.

The Mid-forehead or Direct Brow Lift

The Mid-forehead, sometimes called “Gull Wing,” lift or Direct Brow Lift requires removing a section of skin and underlying tissue above eyebrows or in the forehead. This procedure is best for a patient with a severe brow droop that already has significant forehead wrinkles which hide the incision. It is also preferred for patients with an extremely thin or balding hairline. As it is a less invasive procedure, it can often be done under local anesthesia. The “Gull Wing” beautifully lifts a sagging brow while tightening and smoothing the forehead by pulling the skin and tissue of the forehead down rather than up. It therefore lowers the hairline which is ideal for a receding hairline and/ or a high forehead. This procedure also addresses eyebrow shape and asymmetry. Care is taken to position the scar just along the eyebrows so that it is maximally camouflaged as shown below. Patients will experience some bruising and swelling following the procedure. They are usually comfortable returning to their normal routine activities in about 2 weeks.

Who Should Perform The Eyebrow and Forehead Lift?

When choosing a surgeon to perform an Eyebrow/Forehead Lift, look for a cosmetic and reconstructive facial surgeon who specializes in the eyelids, orbit, and the adjacent structures such as the eyebrows, forehead, cheeks, and midface. Your surgeon’s membership in the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) indicates he or she is not only a board certified ophthalmologist who knows the anatomy and structure of the eyelids and orbit, but also has had extensive training in ophthalmic plastic reconstructive and cosmetic surgery.

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