The eyebrow is a key component of facial expression. Eyebrow position and shape help characterize our appearance. We express ourselves through the position and dynamic movement of the brow. Eyebrows communicate a range of emotions including intrigue, interest, surprise, disappointment, anger and happiness. There are many shapes and positions of the eyebrow. There are several non-surgical options to define and alter the eyebrow shape. When the brows and the underlying fat pads begin to descend with age, it contributes to fullness of the upper eyelid. It can convey unintended emotions that have negative connotations like fatigue, disinterest or even anger. Unconscious attempts to compensate by elevating the brow will accelerate the deepening of horizontal lines on our foreheads. There are few options for truly elevating the brow position besides surgery. Chemical substances like botulinum toxin, can weaken the muscles that depress the brow and achieve mild to moderate elevation. This procedure requires maintenance at intervals of 3- 6 months. The brow can also be shaped or highlighted with make up or by tattoo to give the appearance of being in a higher position. Otherwise there are several surgical approaches to provide true elevation of the eyebrow complex.
WHAT IS A BROW LIFT?
A brow lift is a procedure that produces some elevation of the brow. It can be for the purpose of lifting it’s position or affecting it’s shape. Loose skin and wrinkles of the forehead can be included in the procedure. There are numerous approaches to brow lifts. The choice of procedure depends on the goals of the procedure and the factors that affect the placement of the incision. The classic brow lift approach has an incision across the top of the head from ear to ear. This is considered the gold standard for results but produces a long scar, removal of hair with elevation of the hairline, and some degree of numbness. Other common approaches include incisions in the lateral temporal hair, a series of small endoscopic incisions behind the hairline, incisions at the hairline (a pre-trichal incision), or extending up from a facelift incision, a mid-forehead incisions placed in a forehead wrinkle, incisions directly above the brow and also through an upper eyelid incision during upper blepharoplasty.
HOW LONG DOES IT TAKE TO PERFORM A BROW LIFT?
This will vary by approach. The classic brow lift and several of the other options require special instrumentation, can take more than an hour and are typically performed under general anesthesia. Brow lifts that address primarily the lateral portion of the brow can often be performed under local anesthesia with sedation and can take less than an hour.
HOW DO YOU PERFORM A BROW LIFT?
Dr. Fink specializes in minimally invasive procedures under local anesthesia. With the availability of botox to soften dynamic forehead wrinkles, traditional brow lifts have become less common. Botox can even produce some conservative brow elevation. When the lateral brow position is below the orbital rim, the brow can be lifted with lateral elevation from behind the hair at the temple. Alternatively a direct brow elevation can be performed through the upper eyelid or directly above the brow. The brow is mobilized into position and fixed with permanent or dissolvable suture until it heals into position.
WHO IS A GOOD CANDIDATE FOR A BROW LIFT?
A good candidate for a brow lift is anyone who has heaviness and drooping of the brow below the orbital rim. A male brow is typically flatter in shape and lies at or slightly above the level of the rim. A female brow typically has more shape starting at the level of the orbital rim medially, but gracefully arching above the rim laterally. The maximum peak is lateral to the iris or colored part of the eye. The choice of approach varies by incisions and should be planned according to anticipated hairline changes that happen with aging.
WHAT IS A REALISTIC EXPECTATION FOR A PATIENT HAVING A BROW LIFT?
Most people desire to have the eyebrows at or slightly above the Upper Orbit bone (Orbital Rim). Women naturally have a gentle curve upward over the rim laterally with a peak just above the outer white part of the eye (sclera). As the brow starts to descend with age, this shape may be lost and the brow may even droop below the rim. In this position, removing excess skin with an upper blepharoplasty may pull the eyebrow even lower if it is not stabilized with a brow lift. More frequently, changes are subtle and the final result should appear natural. An over elevated brow can make someone look surprised or quizzical. A brow lift will elevate some the redundant skin off the eyelid. A combined upper blepharoplasty may still be necessary since proper positioning of the brow is the primary goal of the procedure. Forehead lifts elevate the loose skin and can help reduce forehead wrinkles but require higher incisions. The popularity of Botox and the lack of precision and longevity of some forehead lifts have lessened the number of forehead lifts performed in recent years.
WHAT ARE SOME OF THE COMMON REASONS WHY SOMEONE WANTS OR NEEDS A BROW LIFT?
- The eyebrows have descended to make the eyes look tired.
- The normal shape with the lateral arch has been lost.
- An upper blepharoplasty is planned to remove the excess skin but the brow is not in a stable position.
- Forehead wrinkles are evident because the brow is unconsciously being elevated to compensate for droopy eyelids.Botox for the wrinkle will make the brow fall lower accentuating the problem.