There are a variety of surgical procedures which can be used to raise eyebrows. These will be discussed with you and the one selected will be that which is most appropriate to your age, appearance, general health and your specific problems.
The procedures include:
- The direct brow lift
- The endoscopic brow lift
- The transblepharoplasty (internal) brow fixation (Browpexy)
- The transblepharoplasty Endotine Brow Lift
- The pretrichial forehead and brow lift
- The coronal forehead and brow lift
Direct Brow Lift
A direct brow lift is the most powerful brow lift and involves an incision above the brow. It is useful in patients with a marked descent of the brow. Older patients with some pre-existing forehead creases are the best candidates because the scar often blends with these creases well and is less noticeable. A temporal direct brow lift is useful for a patient who requires a moderate lift of the outer aspect of the eyebrow only. The postoperative scar is then confined to the outer aspect of the eyebrow only.
Endoscopic Brow Lift
An endoscopic brow lift is used for moderate degrees of brow ptosis in patients usually aged 40 years and over. It leaves small scars just behind the hairline. It has the benefit of hiding any incisions and scars. An endoscopic brow lift is often performed in conjunction with an upper eyelid belpharoplasty (an upper eyelid lift). It is less suitable for patients with hair loss or thinning of the hair or with a high hairline and prominent forehead.
Transblepharoplasty Brow Fixation (Browpexy)
A trans-blepharoplasty (internal) brow fixation is performed in conjunction with an upper eyelid blepharoplasty. The brow is accessed via the same upper eyelid incision used in the blepharoplasty and released internally from its local attachments and stitched to the lining of the bone just above the brow. The brow is not raised significantly but is prevented from descending any further following the upper eyelid blepharoplasty.
Transblepharoplasty Endotine Brow Lift
A transblepharoplasty (internal) brow lift is used to raise the tail of the brow by placing an Endotine implant in the bone underlying the brow. This implant is effective for patients who have a mild to moderate degree of brow ptosis. The implant dissolves after about 9 months by which time the brow has healed into the elevated position. The implant does, however, add expense to the procedure. The results of the surgery are maintained by 3-4 monthly botulinum toxin injections to weaken the brow depressor muscles.
Pretrichial Brow Lift
The pretrichial brow lift is appropriate for patients with a high hairline who wish to avoid a potential scar above the eyebrow (as would be created by a direct brow lift). Incisions are made just in front of the hairline and the forehead and brow are raised by removing some of the forehead skin at this level. Patients with drooping of the outer part of the brows can have a modified pretrichial lift by making incisions only in the outer (temporal) part of the forehead just in front of the hairline. Some numbness of the scalp is likely to occur behind the incision.
Coronal Forehead & Brow Lift
The coronal forehead and brow lift involves an extensive incision running across the scalp behind the hairline. Some of the skin in this area is removed to pull the forehead and brow up.
The disadvantages of this more invasive approach are the scar and numbness of the scalp behind the incision.