Don’t Let Those Droopy Brows Drag You Down!
If droopy brows are concerning you, then you may be a good candidate for either a browlift or a forehead lift. So what should you do when your face’s best frame needs a lift? We caught up with Dr. Michael Law to find out. Here he highlights the differences between the procedures, the myriad options available, (most of which I was previously unaware of) and whether or not you’re a good candidate.
Brow and forehead lifts are often referenced interchangeably. “Although there are surgical procedures designed to elevate the brow only without producing an overall elevation of the forehead, most browlift procedures involve lifting the forehead and brows together. The forehead, eyebrows, and upper lids are actually one continuous structure that serves as the skin envelope of the area above the eyes,” explains Dr. Law.
The generalized fat atrophy and decrease in skin elasticity that occur with aging and sun damage are factors that accelerate the process of wrinkles and sagging in the brow and forehead area.
So What Are the Options?
- Forehead Lift: This involves surgical mobilization and elevation of the forehead skin, with release of the bands of fibrous tissue that anchor the eyebrow to the boney structure below it (the superior orbital rim). It is the most common browlift procedure performed and can be accomplished by incisions at the hairline or behind the hairline.
- Direct Browlift: This procedure enables surgeons to lift the eyebrows without elevating the forehead skin. This involves the removal of an ellipse of skin along the border of the brows. The closure of this skin excision above the brows results in an elevated brow position. Dr. Law notes that this procedure is generally performed on older male patients with signs of skin aging, for whom the scars will be less noticeable.
- Blepharoplasty: You can elevate the brow position through an upper lid incision at the time of an upper blepharoplasty procedure. “This procedure involves mobilizing the brow soft tissues from the underlying deeper soft tissues through the upper lid crease incisions, and securing the brow at a slightly higher position,” says Dr. Law. He notes that it can limit a surgeon’s ability to produce an ideal brow shape, and it does nothing to rejuvenate the surrounding forehead, temple and lateral periorbital skin and soft tissues.
- Fat Grafting: Dr. Law says that in many cases, the appearance of a lifted brow can be achieved by a fat grafting procedure alone, without elevation of the brow and forehead skin. One way to rejuvenate the brow/upper lid area is by restoring soft tissue volume at the brow/upper lid junction using the patient’s own fat. “Increasing the vertical distance between the upper lid crease and the inferior border of the brow creates the appearance of a conservative and — aesthetically appealing — browlift.”
- Lid Lift + Browlift: The upper lid skin is continuous with the skin of the brow area, so all browlifts improve upper lid skin laxity. “I see many patients who come in for a consultation thinking that they need an upper blepharoplasty when their primary problem is brow descent,” notes Dr. Law. Elevation of the brows by means of a browlift in some patients will completely correct the upper lid skin laxity, particularly when it is performed in concert with structural fat grafting of the brow/upper lid junction. Some patients just need a conservative upper blepharoplasty once the brow area has been rejuvenated..
- Browlifts for High Foreheads: The height of the forehead, (the vertical distance from the top of the brow to the frontal hairline), is a somewhat subtle, but important sign of facial aging. “Some people naturally have a ‘short forehead’ with a low frontal hairline while other people naturally have a ‘tall forehead’ with a high frontal hairline,” Dr. Law says. In general, a lower frontal hairline promotes a more youthful appearance, where a higher hairline promotes a more aged appearance. Dr. Law explains that the best approach for patients with a high frontal hairline is a “hairline incision browlift,” in which a surgical incision is made along the frontal hairline and then tapers into the temporal scalp laterally where it disappears.
Can a Browlift Help With Forehead Wrinkles?
Per Dr. Law, it should absolutely improve horizontal forehead wrinkles, “…both by virtue of restoring subcutaneous fat volume with fat grafting, and by elevating and tightening the skin of the forehead to reduce the overall degree of laxity.” To address the dreaded “eleven lines” Dr. Law recommends an initial trial of Botox to see if you like the appearance with that form of facial expression reduced or eliminated. If you want a permanent interruption of corrugator muscle function, this can be performed during a browlift surgery and also during an upper blepharoplasty surgery.
Who Is a Good Candidate?
Patients and surgeons should together decide whether simulated brow elevation improves the patient’s look overall. “If the patient’s appearance is just different but not better, then it makes no sense to proceed with a browlift surgery that might alter the fundamental ‘personality’ of the face,” notes Dr. Law. He says the aesthetic ideal for the female brow is arched, positioned slightly above the orbital rim with an arch that peaks in the lateral half of the brow, and with a tail that is slightly higher than the medial aspect of the brow. He notes that while some brow elevation can be a good thing, excessively high brows appear unnatural.
So, a multitude of upper facial area concerns can be addressed by a single brow lift, ranging from amping up the brows themselves, to making a large forehead appear smaller, to lessening the appearance of wrinkles and fine lines on the forehead. With a fairly short recovery time, (about a week to ten days), a browlift is a good option for various brow, forehead and hairline area improvements.