Many patients do not realize the importance of the upper third of their face. Many patients will note the cheek jowling, eyelid sagging, and pay little attention to the forehead furrows or sagging eyebrows. Women may camouflage this area with bangs. Cosmetic Botox has helped focus attention on the forehead area.
Quite often, when patients have heavy eyelid skin, the eyebrows contribute to this. One way to check is to place your finger against your eyebrow. In females, the eyebrow should be above the bony eye socket or orbital bone. In males, the eyebrow can be just at the orbital bone, but not below it.
Elevation of the brow can be performed with four approaches. The benefits and risks should be discussed during your consultation.
1. Direct Brow Lift. Incision is made directly above the eyebrow and excess skin is removed to elevate the eyebrow. Unfortunately, this incision may be difficult to camouflage but it is the most straightforward to perform and the brow can be more exactly contoured.
2. Mid Forehead Lift. The incision is made in natural horizontal skin creases in the mid forehead above each brow. These incisions usually heal in time and are an excellent option especially if the patient has deep forehead creases.
3. Full Forehead Lift. There are two approaches for the full forehead lift. If the patient has an average or low hairline, the incision is hidden in the hairline approximately two inches from the forehead. This incision is completely hidden and the entire sagging brow and forehead skin is elevated.
For those patients with high foreheads, the incision can be made at the hair and skin junction. The hair stays exactly in the same position and often an inch of forehead skin is removed. This hides the incision along the hairline and effectively lowers the high forehead.
4. Endoscopic Lift. With this technique, four or five small 1 inch incisions are made in the scalp. A special instrument and small telescope are used to elevate the tissues. Since no excess tissue is removed with this approach, the surgeon anchors the loose tissue with a suture secured to a small screw placed in several locations in the outer skull or through a small bone tunnel made with a tiny drill. A newer technique utilizes an absorbable plate with tiny hooks that hold up the skin.
5. Transblepharoplasty Brow Lift. This newer approach allows the plastic surgeon to elevate the brow through the upper eyelid incision. After removing excess skin from the upper eyelid, the soft tissue along the brow is elevated. An absorbable plate is anchored in the bone and the hooks hold the soft tissue upward.