Many patients complain of a tired or sad appearance. For many of these people, this occurs because their brows and forehead have dropped due to the natural aging process resulting in a hooded, full, heavy look which makes the eyes look smaller. Forehead grooves and frown lines accentuate the problem by making a person appear angry or fatigued. In some young patients the low eyebrow position is simply an inherited characteristic.
These patients need a forehead or brow lift to correct brow position and improve their appearance. A brow lift often kills two birds with one stone. It not only improves brow position but also improves the drooping of the upper eyelids. (Some brow lift patients may also need to remove excess skin in the upper eyelids.) In patients with good brow position removal of only excess skin of the upper eyelids will provide the ideal result. (Link to eyelid surgery) However, in patients with low eyebrows, the best results would be achieved by elevating the brow position with or without removal of excess upper eyelid skin.
TYPES OF FOREHEAD AND BROW LIFTS:
Eyebrow or Mid-Forehead Approach: Incisions are made just above the eyebrow or in a natural crease in the forehead. We rarely recommend this procedure for our patients because the incisions can be conspicuous.
Endoscopic: The brows are raised through small incisions in the scalp just behind the hairline. This works best in patients with low hairlines and mild brow droop. For patients with more extensive aging and excess skin, this procedure gives less favorable results because you cannot remove the excess skin, but simply shifts that skin towards the back of the head. Therefore, the hairline is raised even more than with other approaches.
Coronal: A long incision is made within the scalp behind the hairline. The hairline is raised with this procedure, so we rarely perform this surgery, and only on women with a very low hairline.
ENDOTINE Forehead/Brow Lift: This technique offers a novel solution designed specifically for elevating the forehead tissue in brow lift surgery. Through small scalp incisions the Endotine device is placed under the skin to maintain elevation of the forehead tissue. This creates a more even and gentle distribution of the forehead lift. The result is a rested, relaxed and natural appearance, not a “surprised” look. The incision is concealed within the hairline and women can wear their hair in any style they want following their procedure. However, this procedure also raises the hairline.
Irregular Trichophytic Hairline Incision: The incision is made in the fine hairs at the hairline. For women who have a high hairline or those with hairlines in the correct position, Dr Fleming developed a procedure to camouflage the incision at the hairline. After the brow and forehead are elevated, excess skin is removed and hair follicles are buried deep under the skin closure. These follicles produce hairs which grow through and in front of the incision to hide it, so patients have total freedom of hair styling. Therefore we maintain the hairline in its correct location or lower it for those with a large forehead. Dr. Fleming developed this procedure because the majority of women who need a browlift do not want to raise their hairline. This technique also allows us to lower the hairline for women who have a large forehead, whether or not we lift their brows. For more information on hairline lowering please visit our hairline lowering section. (link to hairline lowering)
For male brow lift patients with a full head of hair, and without recessions, we can apply the same principles as we do for our female patients. However, we must consider the possible progression of male pattern baldness. Therefore, the forehead lift is often combined with hair replacement surgery in men.