One Reason To Consider A Browlift Or Forehead Lift

New patients often come to me for Botox or Dysport injections to their forehead. These patients hate the appearance of deep horizontal wrinkles of their forehead and they think that a Botox injection of the forehead will fix everything. For most of these patients, this is true: a quick easy injection fixes the wrinkles and they are very happy. However, for some of these patients, a Botox or Dysport injection to the forehead smooths out the wrinkles but results in their brows dropping making the forehead feel heavy and making the patient look tired.

Why does this happen? The reason is that the aging process has caused the patient’s forehead to sag causing the eyebrows to push down on the upper eyelids. This results in the excess eyelid skin to hang down over the eyelashes. The patient subconsciously feels the heaviness on their eyes and then they use their forehead muscles to lift up their eyebrows. They are essentially performing their own browlift with their forehead muscles. The unwanted consequence of this auto-browlift is that it causes horizontal wrinkles across the forehead. In these patients, if you do a Botox or Dysport injection to their forehead wrinkles, you weaken their forehead muscles and they can’t perform their auto-browlift. This results in the patient looking tired and making their eyebrows feel heavy.

These patients who are so dependent on their forehead muscles to keep their brows up and their eyes open, with deep horizontal forehead wrinkles, are the patients that would benefit most from a browlift.

Treatment Options for A Browlift

A non-surgical browlift with Botox or Dysport will not work in these patients. This type of non-surgical browlift is not strong enough to correct this much eyebrow sagging. Therefore, the correct treatment option for these patients is a browlift or forehead lift; usually in conjunction with an upper blepharoplasty (removal of excess skin from the upper eyelids).

There are several different ways to perform a forehead lift, and the correct procedure depends on the individual patient’s gender, anatomy, and hairline.

In my opinion, there are two types of browlift that should not be performed. The first is called a direct browlift. In this procedure, the skin is excised directly above the eyebrows resulting in scars that are immediately above the eyebrows. The reason I am not a proponent of this procedure is that the resulting scars are usually very noticeable. The second is a bi-coronal browlift. The incision for a bi-coronal browlift goes from ear to ear over the top of the head. This incision results in long-lasting, and sometimes permanent numbness of the top of the scalp. Also, this scar often widens and can result in hair loss around the scar that is hard to cover up.

To minimize the risk of scarring, hair loss, and numbness,

I usually perform an endoscopic approach browlift. The incisions are hidden in the hair-bearing scalp. These incisions are small, with three incisions measuring three-quarters of an inch long and the two side incisions measuring one and a half inches long. No hair is shaved during the procedure. Through these minimal incisions, the eyebrows are mobilized and repositioned to a more youthful position. Once the eyebrows are set to their new position, the upper blepharoplasty can be performed. Since the eyebrow is elevated into its younger position, less eyelid skin needs to be removed and the length of the upper blepharoplasty incision will be shorter. These procedures can be performed using just local anesthesia in the office or can be performed under anesthesia as an outpatient (meaning you go home after the surgery).

Results of the Browlift / Forehead Lift and Upper Blepharoplasty

Once the eyebrows have been replaced into a more youthful position and the excess upper eyelid skin has been removed, the patient no longer has the heavy sensation of something resting on their eyelids. Because the skin is no longer resting on their eyelashes, they don’t use their forehead muscles anymore to do their own browlift. Therefore, the patient’s forehead is smoother with the wrinkles being improved. The new eyebrow position is usually at the same level as when the patient’s own forehead muscles were doing the lifting. This results in the eyebrows looking natural and not operated upon. The patient’s eyes look brighter and they look more awake. Browlifts are meant to be subtle procedures that accentuate the patient’s eyes, not bring attention to the eyebrows.