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Brow Lift For The Millenium


One of the earliest and most profound signs of aging is the heavy brow or hooded eyes. Often patients seek eyelid surgery to widen their eyes or relieve the tired look. Generally, the real problem is the fact their eyebrows are falling over their orbital rim (the eye socket). With modern techniques, it is possible to decrease horizontal wrinkles in the forehead, smooth the surface, and raise eyebrows above the bony orbital rim. These procedures can be performed as an outpatient under local anesthesia, with only a few days downtime, and the resulting incisions are inconspicuous.

Lifting the forehead and brow as a unit is a popular esthetic surgery procedure. The endoscope has given a new dimension, because we are able to lift the brows and smooth the forehead with minimal evidence of the procedure. This is especially valuable in the balding male, where limited camouflage is available. It is also useful in younger patients who do not require skin excision to reposition the hairline. The open method at or behind the hairline remains the standard for many patients. We use all three of these methods when indicated. A brow lift should be considered in any patient who is contemplating blepharoplasty (eyelid lift) or rhytidectomy (face lift). Complications include small areas of alopecia (hair loss), and anesthesia to the forehead and scalp.

Brow lift was first described at the time of World War 1 (1919) and since then, it has gone through many modifications. In early years the brow was lifted by removing skin directly above the eyebrow. This resulted in a substantial scar on the forehead. With the new endoscopic techniques it is possible to make a very small incision well into the hairline, reach down the skin and muscle and reposition the brow without removing any skin. In severe cases, it is still necessary to remove some skin and subcutaneous tissue for significant long lasting results. The hairline can be repositioned upward or downward with the lifting of the brow.

Before surgery, the amount of forehead lift is estimated with patient in sitting position. This is usually about ½ inch of distance, and it is not necessary to remove much skin in order to get the desired lift.

The distance from the base of the nose to the hairline should be about 1/3 of the lenth of the face. If the forehead is high, it is possible to lower to hairline as much as 1 inch by simply removing the skin and a portion of the frontalis muscle. If the forehead is low, it is possible to raise the hairline 1 inch or so by resecting full thickness skin and scalp in the mid portion of the skull, from ear to ear straight across.

If the hairline is in the correct position and if the required amount of lift is minimal (i.e. ¼ inch or so) or if the patient is a balding male, it is possible to perform this procedure with an endoscope – leaving very little evidence that we were there.

This procedure is usually done under local anesthesia as an outpatient with heavy sedation.

After adequate filtration with local anesthesia and epinephrine to reduce bleeding, the incision is made as described above and the tissues attaching to the frontal bone are gently lifted. This dissection is carried down to the orbital rim (the bony eye socket) and here care is taken to preserve the nerves that give sensation to the forehead and scalp. Bleeding is controlled with electrocautery. The brow is lifted into its desired position. When done through the endoscope, it is often necessary to place a few suspension stitches through a portion of the frontal muscle to hold it upward and backward in the desired position. It is performed by the open techinique. The appropriate amount of skin and scalp are removed, and the wounds closed with absorbable stitches and/or staples.

The most common complication is that portions of the scalp may remain numb for months and even years. This numbness gradually fades, but the sensation rarely returns to completely normal – even if care is taken to preserve all of the sensory nerves. Occasionally excessive bleeding will occur that may require re-operation. Bruising can be profound and patients can have black eyes (and even a red eye) that will last for many weeks. It is not unusual to have a few areas of hair loss (measuring ½ inch or less) and frequently along the incision when it is within the hair. This can always be corrected with a few hair grafts later if necessary.

The results of brow lift procedure are uniformly good. Patients usually have a very high degree of satisfaction.

To view Before and After photos of Endoscopic Brow Lift surgery, Click Here.



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