With aging, the brow can descend over the orbital rims contributing to fullness of the upper lid area (if not being totally responsible for the fullness). In addition, expression in the forehead can create permanent creases as elasticity of the skin is lost and can no longer snap all the way back to the resting position. A family of operations has been developed to deal with these problems referred to collectively as “browlift.” The browlift is, however, not one operation but a spectrum of options available to the surgeon and patient to address specific problems of brow aging.
What is brow ptosis?
What are other manisfestations of brow aging?
What does a browlift accomplish?
Will my hairline be altered by a browlift?
Can a browlift be done at the same time as a facelift?
Besides surgery, is there anything else to do for an aging brow?
Browlifts, regardless of the specific approach, are operations with associated risk, morbidity, and convalescence. Obviously, it would be desirable to be able to achieve similar improvement with therapies that are less involved. This, parenthetically, applies to all areas of cosmetic surgery, not just browlifts. In special cases, treatments of lesser magnitude may produce acceptable results.
Botox is a protein that effectively poisons a muscle into which is injected. Because it is the action of muscle on skin that generates many wrinkles and furrows, eliminating the action of a given muscle may result in aesthetic improvement of the aging lines created by the activity of that muscle. Botox eliminates the function of the corrugator muscles, reducing the depth and possibly eliminating glabellar furrows. The injections are modestly painful and several treatments may be required for optimal results. The benefits are temporary lasting anywhere from 3 to 5 months. Repeat treatment is then necessary. Whether repeated treatment will result in longer lasting and maybe permanent results is not known. Long term systemic effects of Botox are still not totally defined, if indeed there are any in the first place.
Dermal fillers (collagen, Restylane, Juviderm, etc.) may be used to camouflage furrows and creases.. These products ultimately are removed by the body so re-treatment is necessary. Fillers are very safe and injected in the office. The development of longer lasting products continues.
Patients who grow weary of returning for injectables will turn to a browlift for a much longer lasting result. The vast majority of patients who seek rejuvenation of the brow have only one browlift in a lifetime.
What can be done for a tall forehead (high hairline)?
If the incision for a coronal lift is at the hairline (centrally), the hairline can actually be lowered while the brow is elevated. In patients with abnormally high hairlines, a small incision at the interface between hairbearing and non hairbearing may be worth the improvement in the topography of the forehead and brow.
Because the incision is coronal, there will be anesthesia behind the incision. The scar, particularly when it is behind the hairline, is of little aesthetic concern since it is hidden by the hair. Hairline advancement will leave a scar at the junction between the hair bearing and non hairbearing forehead, but they are generally inconspicuous in time.
About the procedure…
What are the types of browlifts?
What is an endoscopic browlift?
What are the advantages of an endoscopic facelift?
What are the disadvantages of an endoscopic facelift?
The main disadvantage of the endoscopic approach is the limited amount of lifting that can be obtained. In patients who need a sizeable amount of ptosis correction, the endoscopic technique may be unsuitable. The judgment of the surgeon and the expectations of the patient determine the utility of this approach on an individual basis. The endoscopic browlift does a poor job of eliminating transverse furrows if they are deep in the forehead. This is because the frontalis muscle is not as easily altered (the muscle that creates these furrows) and because the lifting ability of this technique is limited. The shortcomings of the endoscopic browlift in elevating the brow is reinforced by the number of ways surgeons have chosen to "fix" the brow after its upward movement. Everything from screws to dropwires have been proposed. In general, because so many techniques are proposed, it can be assumed that none works particularly well.
In summary, the endoscopic browlift is most suited for patients who have minimal brow ptosis and satisfactory hairline position or high hairline position (the endoscopic approach does not appreciably effect the resulting hairline). It works well to improve glabellar furrows and transverse creases at the top of the nose. In patients where the hairline should be lowered, the endoscopic browlift has no role. It falls well short of the coronal browlifts when addressing deep transverse forehead creases. In patients with very heavy brows, the coronal browlift, longer incision notwithstanding, is probably a better choice.