Over the last decade, techniques for rejuvenation of the upper third of the face have evolved as both patients and aesthetic surgeons have defined what constitutes a beautiful forehead. The use of neuromuscular toxins, such as Botox TM, is immensely popular because of the relatively low cost, downtime and somewhat predictable results by temporarily blocking the activity of the scowling muscles between the inner eyebrows. Candidates for brow lifts have often used Botox TM in the past but have concerns which are either not completely addressed by injectable therapy or they seek a longer lasting solution.
What is Facial Aging?
Facial aging involves:
- Resorption of facial bones, which then provides less support for the soft tissues;
- Collagen degeneration, which is a natural consequence of aging, sun damage and genetics;
- Static and dynamic lines and/or folds, which results from the repetitive action of the underlying muscle on the overlying skin;
- Lipoatrophy or resorption of fat in the temples.
Patients volunteer that they have been asked if they are angry, tired, and sad; all because their foreheads are marked by horizontal wrinkles/folds, the “11′s” between the inner brows and excess skin hanging over the “tail of the brow”; all based on the descent of the brow.
What to Factor in?
Adjacent aesthetic units, such as the upper eyelid should also be evaluated, in order to formulate a complete surgical plan. Historical factors which are important to elicit include but are not limited to
- Prior upper eyelid lifts
- Environmental allergies (hayfever)
- Ophthalmological surgery (RK and/or LASIK)
- Dry eyes (keratitis conjuctivitis sicca or Sjogren’s Syndrome)
- Bell’s palsy affecting the muscles involved in eyelid closure
The pattern of scalp hair growth is also relevant in planning surgical incisions, as hair loss may occur.
BROW LIFTS CORRECT OR MINIMIZE THE FOLLOWING CONDITIONS:
- Creases on the forehead, bridge of the nose and between the eyes
- Frown lines or vertical creases between the eyebrows
- Low or sagging brow that bulges over the upper eyelids
- Flattening of the tail of the brow
Brow Lifts are scheduled under either local anesthesia or MAC (Monitored Anesthesia Care) sedation. The choice of technique is predicated on the patient’s anatomy and desired aesthetic outcome, however most involve modification (cutting) the scowling muscles, and repositioning of the descended brow by freeing it up from its tethering points, especially in the tail, which gives a better lateral (outer) arch to the brow. Select patients who request direct excisional browpexy, (removal of skin above the tail of the brow) can be done under local anesthesia.
Brow Lift Techniques
- Open coronal brow lift: requires an incision either in the scalp or in front of it, spanning from ear to ear. The technique has largely been abandoned because of the potential for hair loss, scalp sensory disturbances and over elevation of the brows.
- Endoscopic brow lift: shortens the incision, approximately 40%. It is similar to the “classic” open approach in releasing the forehead flap from its original points of fixation, cutting the scowl muscles, reshaping the outer brow but differs in the manner in which the “correction” is maintained, i.e. screws or bioabsorbable plates, instead of excision of scalp or forehead skin. Modification of the hyperdynamic scowl muscles is less effective hence Botox may be used, in smaller doses and less frequent intervals, post-op.
- Transbleph browpexy: uses the upper eyelid incision to release the tail of the brow, reposition it more superiorly and fixes it onto the skull with a bioabsorbable plate. Concurrent excision of upper eyelid skin may accentuate results.
- Direct excisional browpexy: removes redundant skin above the tail of the brow, taking advantage of a natural line or wrinkle to conceal the scar. It is most applicable for bald men, (whose wrinkles are deep and do not have adequate hair to conceal endoscopic ports) or younger women, with minimal defects, who are willing to have a scar, parallel to the tail of the brow.
Brow lifts and Botox TM are not mutually exclusive, especially with the contemporary techniques; however the frequency of treatment or number of units can be expected to decrease.
Swelling and bruising are expected but will diminish over the next few weeks. Drains are removed post-op day 1 and staples in a week. Patients return to modified activities driving and work, when they have weaned off pain medications, usually within a week. We recommend a more gradual resumption of heavy physical activities, at typically four weeks.
Non-operative “solutions” are proposed according to the patient’s anatomy and may include:
- Botox which temporarily (4-6 months) block the function of the scowling muscles and provide minor elevation of the tail of the brow
- Dermal fillers which provide support of the outer brow and soften scowl lines; average duration 4-6 months
Rejuvenate your appearance with a brow lift. Call our office in Newport Beach to schedule a consultation with Dr. Chong at (949) 644-1400.