High
Brows
The Fine Art of Brow Lifting
One of the most overlooked aspects of the aging face is the brow area,
defined as the upper third of the face from the eyebrows to the natural
hairline. When most women look in the mirror, the puffiness and crepiness
of the lids is singled out as the reason for why you think you look 'tired'.
Some people have a low positioned brow to begin with, and along with everything
else, brows sag as we age. "When patients complain that their eyelids
are baggy, it may have nothing to do with the eye at all. It may be that
the brow has come down," says Barry Jones, President of The
British Association of Aesthetic Plastic Surgeons, "It makes a huge
difference to facial aesthetic surgery being able to lift the brow."
If you really need a browlift, having your upper lids done instead will
often not achieve your goal from the surgery, and in fact may actually
pull the brow down more.
"There
is a marked increase in endoscopic techniques being used in forehead and
browlifting and the advantages over the bi-coronal technique are less
scarring and swelling, reduced risk of numbness, hair loss, hematoma,
and increased patient acceptance," says Thomas Romo III,
MD, Chief of Facial Plastic and Reconstructive
Surgery at Lenox Hill Hospital. The conventional browlift (open or coronal
lift) has been abandoned by some surgeons who favor the less invasive
endoscopic approach. The open procedure involves repositioning and removing
excess skin through an incision which runs across the scalp from a point
above the ear and closed with staples. The endoscopic browlift is performed
via 3, 4 or 5 short vertical incisions of approximately 1/2" behind the
hairline using an endoscope, camera, and light source to do the work.
However, there are surgeons who still prefer a traditional approach and
cite more permanent results and greater reliability and predictability
as their primary reasons. The method has evolved over time and surgeons
have adjusted their choices for fixing the brow in its place with improved
suturing, staples and screws. One of the latest methods utilizes a tiny
screw tunneled into the bone and held in place with dissolving suture
material designed to last longer.
For patients who have a high hairline or thinning hair, who are concerned
about their hairline moving back, browlift surgery may not be a viable
choice. Your hairline will usually be moved back, although considerably
less with an endoscopic procedure. Another technique utilizes an incision
along the hairline itself to lower the hairline. This procedure results
in a visible scar which may or may not heal to your liking. In rare cases,
a direct approach may be suggested which involves an incision in the brow
itself, also resulting in a scar which is visible and more difficult to
conceal.
If you are indecisive about whether to have a browlift or frightened at
the concept of it, you might wind up regretting your choice and returning
a year later to have it done. If your brow area is sagging and it is not
corrected at the same time as your face and neck, the top third of your
face may effectively look older than the rest. If you are adamant about
avoiding the browlift scar, ask your surgeon to consider an endoscopic
procedure as an alternative for you. Patients who don't want a brow-lift
are usually responding to a bad result they have seen in someone else.
"I don't want to look surprised," is a common quip. The eyebrows can sometimes
look slightly high immediately following surgery, but most surgeons will
tell you that they will settle down as the swelling resolves.