Brow surgery CENTER FOR FACIAL PLASTIC SURGERY AT ENT SPECIALISTS

Brow surgery

Many patients are surprised that a browlift is necessary at the time of upper blepharoplasty (upper eyelid lift surgery) in order to adequately address the excess skin on the upper eyelids. When the brows are droopy (Brow ptosis) the eyelid skin is pushed down, adding to the excess skin on the upper eyelid. Simply removing extra skin from the eyelids does not improve the result and can lead to an even lower position of the brows and difficulty closing the eyes. In extreme cases, excessive eyelid skin removal can lead to brow hair blocking the visual axis. This can be prevented by judiciously removing skin from the upper eyelids and performing a brow lift whenever necessary in order to achieve the optimal functional and cosmetic result. For these reasons, choosing a surgeon that specializes in eyelid and periocular rejuvenation will ensure the best result with minimal risk of complications.

Dr Georgescu performs 10 different brow lifting techniques: Internal Brow Suspension (Browpexy), Internal Brow Sculpting, Brow Fat Transposition, Brassier Suture Lift, Corrugator Muscle Removal, Endoscopic Forehead Lift, Temporal Lift, Pre-trichial Lift, Coronal Lift and Direct Brow Lift. He will discuss and choose with you the procedure that suits your needs best and that will give you the best cosmetic result.

Browpexy, Internal Brow Sculpting, Brow Fat Transposition and Corrugator Removal are performed through the same incision as the upper blepharoplasty. The endoscopic brow lift is a forehead lift performed via four small incision behind the hairline. A temporal lift is performed through an elliptical incision strategically placed in the hairline above the lateral part of the brow. Each technique is carefully selected on an individualized basis depending on patient’s anatomy and desired result.

Internal Brow Lift. An Internal Brow Lift, also known as Internal Brow Suspension or Browpexy, attaches the brow fat to a higher position using internal sutures. The sutures dissolve after 3 months, when the brow has already fixated in the desired position. This procedure is performed through the same upper blepharoplasty incision that is used to remove the excess skin and reposition the excess fat. The main advantage of Internal Brow Suspension is that no additional incisions are required, which reduces surgery time and the risk of scarring.

The Brow Fat Flap technique that I developed has completely revolutionized brow-lifting surgery in my practice. In this procedure, I transfer the brow fat horizontally instead of vertically using the same upper blepharoplasty incision, which has the following effects: it lifts the brow by an average 2.5 mm, it restores the convexity of the eyelid-brow junction in the central third of the brow where the age-related volume loss is most severe and it completely removes the lateral hooding.

Internal Brow Suspension typically lifts the lateral part of the brow (tail of brow) more than the medial part of the brow, creating a higher lateral arch. This is ideal for women because the lateral brow is typically higher than the medial brow in women. However, the Internal Brow Suspension can also be used in men with severely depressed (droopy) brow tail.

My own published studies, as well as other studies, have shown that Internal Brow Suspension is 80% as effective as the Endoscopic Brow Lift, the most effective modern brow lifting procedure. This is important because the Internal Brow Suspension can be performed significantly faster than the endoscopic brow lift, uses the same upper eyelid incision and can be done under local anesthesia.

Endoscopic brow lift. An Endoscopic Brow or Endobrow Lift uses a fine endoscope (a surgical instrument with a camera) and four tiny incisions behind the hair line to lift the forehead and the brows. At the same time, it tightens the skin in the outer corners of the eyes and improves the cheek position and shape. It is the most effective modern brow lifting procedure and has the advantage of lifting both medial and lateral brow independently. It is a very customizable procedure that can be used to adjust the brow position and shape on an individualized basis.

The incisions are less than 2 cm long and situated behind the hairline, making them invisible. There is no hair loss with this procedure. The procedure is performed under general anesthesia for patient comfort, but there is no postoperative pain. A wrap is placed over the forehead overnight to decrease the risk of bleeding and swelling. All sutures dissolve at 10 to 14 days.

Despite being performed under general anesthesia, recovery is similar to that of the other brow lifting procedures.

Corrugator Removal. The Corrugator Removal technique eliminates the muscles that produce the frown lines (also called the “11 lines”) and that also pull the brows down and in. It is very effective at lifting the medial part of the brow for which reason it is an excellent technique for women that have a high lateral arch. This avoids the surprised look seen when the lateral part of the brow is too high compared to the medial brow. Corrugator removal is also ideal for men because it preserves the flat brow configuration that is typical in men. As opposed to Botox, the effect of this procedure on the 11 lines is permanent, for which reason it is called a “Permanent Botox effect”.

Recovery is similar to that of upper blepharoplasty except that the central part of the forehead remains numb for about 6 months in 95% of patients. In 5% of cases, the nerves never recover completely and the patient remains with some decreased sensation between or above the brows. The patient may also experience tingling or shooting pain in the same area while the nerves recover (the first 6 months after surgery). This typically resolves with time or with appropriate medication.

Temporal Lift. The Temporal Lift is done through a small incision in the temple behind the hair line. It lifts the tail of the brow and the corner of the eye. Similar to the internal brow suspension, the temporal lift is very effective on the lateral brow (brow tail) but has virtually no effect on the medial brow. Consequently, this procedure is ideal for women with a flat brow configuration where the lateral brow benefits more from being lifted than the medial brow.

Although this procedure requires a different incision from the blepharoplasty, the scar is invisible once healed because of a special technique that allows the hair shafts to grow through the incision line.