Brow lift surgery has evolved significantly since its early descriptions. Early procedures involved various incisions above the brow in folds and creases. These more direct lifts (called direct because of their proximity to the brows) are powerful, but can lead to obvious scars, loss of brow hair, and irregular brow contours.
Surgery then evolved to large hidden incisions behind the hairline (through an open or coronal approach). While less powerful than the more direct lifts, these tend to be more aesthetically pleasing and are longer lasting. However, this open approach to a brow lift is still an incredibly invasive procedure that can lead to unfavorable and long-lasting negative side-effects such as:
- mild to moderate hair loss along the incision line
- prolonged numbness
- tingling, itching and other strange sensations
- visible bruising and swelling
Endoscopic brow lifting was then introduced, which in many ways has revolutionized the surgery. The Endoscopic procedure is a more advanced technology, which requires a strong understanding and familiarization with the equipment used by a qualified plastic surgeon. In this minimally invasive technique, small post-hairline incisions are made, through which a lighted endoscope (an instrument which can be introduced into the body to give a view of its internal parts) is used to release the brow internally. Then, the brows are lifted and fixated into a new and elevated position. This new brow lift technique rarely produces hair loss, and the other side effects related to the open approach are much less severe and shorter lived. Endoscopic brow lifts are also favorable because they leave no obvious incisions or scars once healed, and the benefits are long-lasting.
Finally, there are various procedures described which lift/support the brows from eyelid incisions. In my view, these “browpexy” procedures are more adjuncts to formal brow lifts than standalone procedures with cosmetic brow lifts.
With this history of procedures in mind…What do I feel is best for patients? Here are my rules:
- Brow lifts are not only about height, but about shape, arch and contour. This does not mean height is not important – it is; that’s why the surgery is called a brow lift. However, I prefer the term “brow-recontour” – as the shape, arch and contour must be evaluated and planned to assure a nice aesthetic result
- The brows and upper lids should always be considered together as one aesthetic unit – (learn more about this in an earlier post – The Brow and Upper Eyelid as an Aesthetic Unit.) The brow and upper lid normally transition smoothly in youth, and must be the aesthetic goal when surgically addressing these structures as we age.
- Pay attention to, and emphasize, the outer brow. It has been shown that the outer brow preferentially drops with age. This should be the emphasis of brow lifts as not to create and unusual shape to the brow after surgery.
- Anyone who has skin overhanging the upper lids beyond the lateral canthus (where the outer upper and lower lid meets) is a candidate for an outer brow lift. Otherwise, to address this skin, the eyelid incision must be elongated beyond the eyelid crease. (This can at times lead to an unsightly scar.)
- Never over lift the brow. This surgery is about subtle adjustments to allow appropriate eyelid surgery and a natural look.
Below are a few examples of brow lift surgery in my hands. I almost exclusively perform the endoscopic lift and always focus on brow shape, arch, contour and how the brow and upper lid transition smoothly together. Watch the before and after of this procedure in action in this video: Endoscopic Brow Lift Video | Before & After Brow Lift.
For more information on endoscopic brow lifts visit https://drmassry.comcontent/endoscopic-browlift
Contact Dr. Massry to Learn More!
If you are interested in learning more information on brow lifting surgery, or would like to schedule a consultation, please feel free to contact Dr. Massry at 310 657-4302 or at drmassry.com.
You may also purchase my medical text or video on this topic here:
Video: Aesthetic Eyelid and Periorbital Surgery: Surgical Adjuncts and Pearls for Success
Text: Pearls and Pitfalls in Cosmetic Oculoplastic Surgery
The first 2 examples below show the Before image on the left and After on the right.
The bottom image shows the Before image on top and the After on the bottom.