Aging affects all structures in the body, both soft tissue and bone undergo remarkable changes, most visible changes show first in the face, specially around the eyes. It demonstrates itself as a sagg or lowering of the eyebrows, normally because of the gravitation forces, loss of elasticity in skin, ligaments, and even the atrophy of bone structure, this part of the face is one of the most dynamic parts in the face, aging shows off particularly around the eyes.
The treatment of brows ptosis (brow sagging) can be done by a variety of techniques, most of which are based on some type of superior scalp incisional approach. The older traditional full coronal incision has been abandoned and is replaced by a much more limited surgery, the endoscopic technique which requires smaller incisions and a faster recovery with far less complication risks, this has made the operation even more attractive to younger patients .
An intermediate browlift technique or the so called hairline method can be a better alternative in many cases, though the endoscopic browlift has it’s limitations and the results normally o not persist more than 3 years, in a still larger group of patients can this method be the operation of choice. The only disadvantage of this method is how well the hairline scar appears.
One of the important components of eyebrow shape is whether the patient has an eyebrow arch. A small arch in the middle of the eyebrow helps create a nice frame for the eye. But not everyone is fortunate to have an arch in the his/her eyebrow. In modern facial aesthetic surgery we have numerous options to create this, most commonly by plucking /threading/shaving but also by tattoos, hair transplantation, fat grafting, and many more complementary technique which will be discussed with you individually during consultation.
Aesthetically the peak of the arch is not in the middle of eyebrow but normally just a bit more laterally, and normally not as a fully symmetric rainbow. A combination of reshaping surgery procedures plus fat injections can give a lifting effect and restore the volumes lost by age. By adding volume directly beneath eyebrowa at specific parts, an outward and upward push of eyebrow occures.
Traditional and endoscopic browlifts are performed under general anesthesia. During a traditional browlift, a beveled frontal hairline incision is made behind the hairline, this extends into the high temporal area, the forehead tissue is elevated off the bone and below the ridge åeriosteum is separated and lifted, exposing the supraorbital neurovascular bundles on each side. Portions of corrugator and procerus muscles are removed centrally and around the nerves, horizontal strips of frontalis muscle are removed in two separate rows, the forehead skin is lifted to create the desired browlifting effect as well as temporal scalp skin out laterally. The overlapping forehead skin and scalp tissue are trimmed, the deeper tissue is secured to the galea and deep temporal fascia and then the incisions are closed.
Recovery from a traditional browlift operation depends on the extent of bruising and swelling which occurs around the eyelids. That in turn is influenced by whether any blepharoplasty surgery is done simultaneously. When done without simultaneous blepharoplasty, one can be in pretty good condition in one week, if done with accompanying blepharoplasty , the recovery time can extend to 10-14 days.
Disadvantages of traditional browlift are in some cases a fine but visible scar line along the frontal hairline, this will heal very well in most cases, in some cases in patients with more pigment in their skin, there can be seen a persisting hypopigmentation at the scar line. Other disadvantages of this operation is the unavoidable trisection of sensory nerve branches as they cross into the scalp. This will cause some TEMPORARY numbness of the frontal scalp, which normally persists up to 9 months.
In patients who have a very short front, we prefer to perform the more traditional CORONAL incision.
The most popular technique is the endoscopic technique which uses a few small scalp incisions and an epicranial tissue shift to create a browlift effect, the lift effect is not as significant as the traditional oronal incisiion or the hairline technique, but it has the advantage of lack of significant incision lines.
In properly selected patients (patients with good frontal hair density), the best method of choice is the hairline incision technique, because the operation will not lead to a forehead elongation and the scar is well hidden along the hairline. Studies have confirmed hairline incision technique does not affect the long term persistence of hair density, in fact more patients with this incision have shown mores table results, without elongation of forehead or increased risks or signs of recession. This is of special value to female patients where we do not desire frontal or temporal line hair loss or forehead elongation.
A less common method is to incise along the upper border of the eyebrow and excise a strip of skin, this can give the best result in some patients, however this is not a method of choice in female patients. Which technique is used depends very much on the quality of skin, the density of hair, the length of forehead, and degree of eyebrow and forehead ptosis.
In most cases combining a browlift with blepharoplasties creates the most complete periorbital rejuvenation.
Repositioning of an aesthetically low eyebrow can be done by a variety of browlift procedures. Lifting up or pulling back in the right direction is the common point in all these procedures. A more recent approach to lifting the low brow is to push it up from below. This is done by a transpalpebral (through the upper eyelid) browlift technique which uses a device (endotine) to achieve a browlift. This method is a valuable technique specially in male patients because of the dubious nature of their hairlines. Scalp approaches in men are usually unacceptable because of visible scar concerns.
The ideal Candidates for browlift surgery are patients with visible signs of aging in forehead and periorbital area, previous blepharoplasties or even eyebrowlifts are not a direct hinder for new operations, baldness or low density of hair in frontal or temporal lines do not make a patient a less ideal patient for the operation.