A brow lift can help the appearance of heavy sagging eyebrows. It can help restore a youthful appearance and in some cases improve vision. The position of the eyelid in relation to the brow is very important in determining the optimal procedure for upper lid and upper facial rejuvenation.
There are several different ways to perform a brow lift. Each type of procedure has its own advantages and disadvantages. The choice of procedure is determined on a patient specific basis and takes many factors into account including the position of the brow, heaviness of the brow tissue, presence or absence of forehead lines, position of the hairline, and forehead muscle function. Some of the more common types of brow lifting procedures are described below.
Types of brow lifts:
Direct Brow Lift
The direct brow lift is an older procedure that involves making an incision above the eyebrow or in a forehead line. Tissue is removed and sutures are used to carefully close the incision. The direct brow lift is a powerful procedure that can lift even the heaviest and non-functional brows. It is a quick procedure and can be performed under local anesthesia. The main disadvantage is that there is a high likelihood of a scar. Due to this, the direct brow lift is usually reserved for patients with heavy brows with deep forehead lines or forehead paralysis. It is occasionally also used for functional brow lifts where the brow is so heavy that it impairs vision. It is rarely ever performed for purely cosmetic purposes.
Trans-Blepharoplasty Brow lift or Browpexy
The Trans-Blepharoplasty brow lift (also called a trans-bleph brow lift or browpexy) is a brow lift that is performed through the same incision as an upper eyelid blepharoplasty. After the upper blepharoplasty incision is created, the tissues of the eyebrow are carefully dissected and lifted. The released eyebrow tissue is secured to the bone using either sutures of a specialized fixation device. The sub brow fat can also be released and repositioned if necessary.
There are several advantages to the trans-blepharoplasty brow lift. If an upper blepharoplasty is already being performed, then no new incision is necessary. It is a relatively quick procedure and adds minimal time to a standard upper blepharoplasty. Also, because the incision is on the lid, the sub brow fat can be directly visualized and can be easily repositioned if necessary. The main limitations of the trans-bleph brow lift are that it not ideal for heavy brows and may not be long lasting for some patients. Also, the central forehead is not easily addressed with this procedure.
Temporal Brow Lift
The temporal brow lift is a powerful procedure that is excellent at addressing sagging brows and hooding. The incision is hidden in the temple behind the hairline. The tissues of the forehead are released down to the eyebrows. The brow and forehead is then lifted and excess tissue is removed. The lift is anchored to a sturdy deep layer of tissue called the deep temporal fascia. The incision is then closed with skin staples that are removed in about a week.
The temporal brow lift has many advantages. Because tissue is removed, it can provide a very powerful lift, while the incision behind the hairline allows the hair to hide any scar. Also, the temporal brow lift does not require any special fixation devices. Although an endoscope may be used for this type of lift, it is usually not necessary. The main limitation of the temporal brow lift is that it does not directly address the central forehead, although issue is commonly solved by performing and extended version of the procedure.
Endoscopic Brow Lift
The endoscopic brow lift is similar to a temporal brow lift, except and endoscope is used and central forehead incisions are also created to release the central brow. As with the temporal lift, the incisions are placed behind the hairline to hide any scar. The lift can be anchored in the same way as a temporal brow lift, or a fixation device can be used.
The advantage of the endoscopic brow lift is that is can lift the entire forehead. There are many variations of the procedure to address specific eyebrow and forehead issues. The main limitation is the possibility of overcorrection. As with the temporal brow lift, thinning hair or a receding hairline can make the scars visible.
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