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| Raising a Few Eyebrows: An Expert's Guide |
| By Paul G. Pin, MD Dallas, TX |
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When Should I Start Thinking About Cosmetic Surgery?
I hear this question a lot from middle-aged women and men who are beginning to notice the first signs of facial aging. Some lucky people are somehow genetically protected from aging and look great well into their 60s. The rest of us watch them with envy from around age 40, when our brows begin to settle.
Often the effects of a settling brow first become apparent when a well-meaning friend or family member comments on appearance: "Are you angry?" "Are you tired?" "You look unhappy…" Looking in the mirror, an individual may notice a more "low-brow" appearance.
Brow position has a big impact on the way the face looks. The condition of the brows affects the excess tissue in our upper eyelids, particularly in the outer portion where "crow's feet" develop. Patients with droopy (ptotic) brows frequently seek help because the excess skin obscures their upper lids. Women with droopy brows have a hard time wearing eye shadow, and all individuals with droopy brows may feel that their eyes look smaller.
Few patients realize it is their brows that need treatment rather than just their eyelids. During a consultation, however, it is easy to demonstrate how they will look with their brows elevated. Patients can expect to look refreshed, happier, and more open-eyed following a brow-lift. The procedure can also dramatically reduce forehead wrinkles and frown lines. The most common concern patients have is that they will look surprised or startled.
Brow-Lift Procedures
There are Three Different Approaches to Brow Elevation: endoscopic, hairline and coronal.
For an endoscopic brow-lift, two or three incisions, each about an inch in length, are made just behind the hairline. A camera called an endoscope is then inserted in the incisions and used to free the brows so they can be elevated.
Endoscopic brow-lifts have been in use for about five years, following the development of technology that allows the surgeon to elevate the brows through limited incisions. Although less invasive than other procedures, endoscopic brow-lifts are also more unpredictable in outcome. Some patients achieve their goals, while others experience minimal long-term improvement. Because of this limitation, endoscopic brow-lifts are best used with patients who are especially averse to long incisions or desire only subtle brow elevation.
Coronal and hairline brow-lifts rely on more traditional techniques involving long incisions. In a hairline brow-lift, the incision is made at the hairline. In a coronal brow-lift, the incision is made about four inches behind the hairline.
One of the results of a coronal browlift is the hairline will be shifted backwards. This technique is therefore useful in patients with thick hair and a low or normal hairline. Hairline browlifts, on the other hand, actually reduce the height of the forehead, making them more popular for patients with long foreheads (or high hairlines).
Side effects of coronal and hairline brow-lifts include some scalp numbness following the procedure. Despite this limitation, coronal and hairline brow-lifts tend to be more effective and reliable than endoscopic brow-lifts.
In the final analysis, however, there is no "right" way to perform a brow-lift. As with any cosmetic surgical procedure, the advantages and disadvantages of a given technique have to be considered in light of a patient's goals and preferences.
Recovering from Browlift Surgery
Recovery following a brow-lift procedure also depends entirely on the individual patient and course of treatment. If a brow-lift is part of a full face-lift, recovery will be lengthier than if the brow-lift is performed on its own or in conjunction with an eye-lift (blepharoplasty). Done under general anesthesia as an outpatient procedure, brow-lifts result in significant swelling and bruising for a few days, and most patients report moderate discomfort. Fortunately, recovery is rapid and most patients can return to work within a week or so.
A brow-lift can restore a rested, more youthful appearance to the upper face. Patients frequently find a brow-lift makes them look as good as they feel.
Browlift surgery is real surgery and involves risks such as bleeding, infection and scarring. Results will vary, and your expectations and risks should be discussed with a board- certified plastic surgeon.
Paul G. Pin, M.D., is a plastic surgeon board-certified by The American Board of Plastic Surgery who practices in Dallas, Texas.
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