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Forehead and Brow lift are often used interchangeably. The goal is to reduce forehead wrinkles and elevate the eyebrow.
Eyebrows tend to drop with aging. When eyebrows start to sag, they can bestow a look of tiredness or even anger. For this reason, forehead and eye surgery can be viewed as surgery that improves your expression as well as your appearance.
An understanding of the aesthetic ideals is paramount in creating beautiful, natural results with brow lifting. Dr. Neavin has studied eyebrow shape and position at the University of Pittsburgh by analyzing female models. He has presented his findings in plastic surgery meetings.
Dr. Neavin also performs eyebrow transplantation with renown celebrity makeup artist, Scott Barnes. Eyebrow transplantation can provide lifting and reshaping in certain individuals who have thin eyebrows.
Types of brow lifts
Brow lifts can be performed either in endoscopic or open fashions. Endoscopic approaches use several small, well-hidden incisions in the hairline. Open approaches are performed with incisions either at the hairline (pretrichial) or in the middle of the scalp (transcoronal).
Forehead lifts can be done in a few ways. One is the pretrichial approach, where the incision is made along the hairline. This is a great approach when the forehead is too large – yes, hairlines recede in women, too. Reducing the height of the forehead to its proper balance (one-third) of the face height dramatically rejuvenates the face to restore youth. The incision is placed in zigzags to camouflage the scar, and incised in a beveled fashion to make sure follicles grow through the incision to further conceal the scar.
An advantage to the pretrichial incision that the other approaches cannot offer is that the forehead size can be reduced and the hairline lowered. Thus, in women who have a large forehead marked by a receding hairline, the pretrichial brow lift not only raises the eyebrow but lowers the hairline. In men, this approach may be less desirable if there is a pattern of aggressive hairline recession or male pattern hair loss since the scar may become visible if the hairline recedes.
Transcoronal Brow Lift
The transcoronal brow lift involves an incision virtually from ear to ear within the scalp. The scalp is excised and the brow is elevated. The scar is well hidden within the hair. This approach is ideal for men or women who have a low hairline, as this technique may raise the hairline.
An endoscopic brow lift does not alter the hairline position. The advantage of the endoscopic approach is that there are no large incisions. Instead, there are several smaller incisions within the hair-bearing areas of the scalp. Many opponents of the endoscopic browlift claim the results are more short-lived, but this is a debatable point.
Forehead lifts and brow lifts are often combined with other face surgery to further enhance results and avoid patchwork-type rejuvenation.
The surgical approach to open and endoscopic approaches differs in access and suspension. For the open approaches, pretrichial and transcoronal, incision are made either along the hairline or in the mid-scalp, respectively. Dissection is carried down the subperiosteal plane to the superior orbital rim. Tissue is freed up and the under-surface of the frontalis muscle may be scored to reduce wrinkles. A more mobile skin composite will allow easier elevation and reshaping of the brows.
If the approach is pretrichial, skin is excised below the hairline to allow for both elevation of the eyebrow and descent of the hairline. The effect is a forehead reduction as well as eyebrow lifting. The corrugator and procerus muscles that act to create the 11’s between the nose are cut or excised. Eyebrows are secured into place by the removal of tissue. Incisons are closed with fine stitches that will be removed in our office in seven or eight days.
With the transcoronal approach, dissection plane, muscle scoring and brow securing is identical to the pretrichial approach. The difference rests in the placement of the incision and the forehead changes. The incision runs from ear to ear and is closed with both stitches and staples. Unlike the pretrichial approach, the transcoronal approach does not reduce forehead length. In fact, it may enlarge it since skin resection is within the hair bearing scalp. Staples, not stitches, are removed generally within two weeks.
With an endoscopic approach, several small vertical incisions are made within hair-bearing areas of the scalp close to the hairline. The dissection and tissue releases are similar to the open approaches. Because no skin is excised with this approach, the eyebrow is secured with barbed endotines under the skin which dissolve over time. The incisions are stapled and staples are removed in our office about two weeks after your surgery.
It has been argued that the results of the open approaches last longer than endoscopic approaches. It should be noted that in all approaches, relaxation of the tissues following surgery results in some descent of the brow. Thus, slight over-correction may be in order in certain individuals to ensure positive results over time.
To avoid the surprised look that has given brow lifts a bad name, brow shape, not just brow position, must be respected. The arch of the brow should be gentle with the peak at or above the lateral limbus of the eye. Brow position in women is generally about 1 cm above the superior orbital rim. In men, the brow generally is more flat and sits at or just above the rim.
To learn more about eyebrow shape and position, Dr. Neavin urges you to schedule an appointment in the office with him. You can also make an appointment with renowned celebrity make-up artist, Scott Barnes, with whom Dr. Neavin often works for eyebrow transplantation. Contact Artisan of Beauty Plastic Surgery today at 310-858-8811 or text 323-975-1287.