Even with BOTOX® Cosmetic being so popular for reducing the “11’s” and subtly raising the eyebrows, we are experiencing an ever increasing demand for a more permanent solution for eyebrow elevation. It has been over twenty years since Dr. Stephens worked with his colleagues in developing the invisible hidden-incision, endoscopic-assisted brow lift. The procedure has remained effective for a subtle and elegant eyebrow elevation that softens the forehead and opens the area around the eyes. Prior to this, forehead lifts, also called brow lifts, utilized the “traditional coronal” brow lift, consisting of an incision that extended from the top of the head to each ear. While this is effective and is still used by some surgeons, it is very aggressive and can result in an extreme “surprised” look as well as a significant numbness of the scalp; the scar can also be a problem.
Often our patients who request a “brow lift” confide that their friends and colleagues say that they look angry or tired where they are actually very happy and energetic people and want their face to express this. In the competitive marketplace, people may have jobs and professions where they need to look approachable and relaxed. The brow lift should never look surprised but should provide a softened, refreshed appearance.
In some cases, patients ask if they need to have the skin of their upper eyelids removed, (an upper eyelid blepharoplasty). While they may need this, the skin around the eyebrow above the eyelid also needs to, “get out of the way” to allow the area above the eye to open up. In fact, in some cases, there is a heavy brow and a “deep-set eye” that has been there since youth but is now more relaxed and now crowds the area around the eyes where a brow lift alone is the best treatment. The brow lift can often improve the upper vision, the visual field in the area impairing vision.
Types of Brow Lifts
Dr. Stephens generally performs two types of brow lifts depending on the quality and looseness of the skin, the endoscopic brow lift and the subcutaneous brow lift. In some cases, such as a facelift, the lateral brow lift is often utilized to take up the residual skin above the sideburn although it can be performed as an isolated procedure.
The endoscopic brow lift: This is indicated In younger patients with tighter, firmer forehead skin. The endoscopic approach lifts the whole area of the forehead, brow, and temples as well as the area around the outside of the eyes. It also can be used to remove the frown muscles that create those “11’s” and frown lines between the eyebrows. It is performed utilizing small hidden incisions behind the hairline that are unnoticeable once they have healed. There is a remarkably short recovery and hair loss is avoided. A specialized, tiny telescope is placed through these small incisions to provide remarkable direct access to the forehead structures.
The Endoscopic Brow Lift:
- Utilizes four to five tiny incisions, resulting in minimal hidden scars behind the hairline
- Uses an endoscope (a tiny telescope that utilizes a camera and light source) and specialized instruments that allows the surgeon to visualize and manipulate the internal structures under microscopic vision
- Allows for a faster recovery time and less pain
- Does not efficiently eliminate excess skin in older patients or those with loose skin
The subcutaneous brow lift: this is used in older patients or those with loose skin. The hairline approach is used and the skin is lifted in the more superficial-subcutaneous plane that is immediately below the skin, between it and the forehead muscle to tighten it and reduce the forehead wrinkles in addition to lifting the eyebrows.
The subcutaneous brow lift:
- Utilizes an incision hidden along or within the hairline above the forehead
- The skin is lifted above the deeper structures in the forehead to give the surgeon more access to looser skin
- Excess skin is removed, and the new brow position is secured as the incision is sutured together
- The hairline can also be lowered by using an extended hairline approach
- Numbness behind the incision may persist for nine to twelve months
- Does not affect the frown muscles; however, these may be approached through the upper eyelids
Take the guesswork out of Plastic Surgery
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