Lateral Browlift: a conservative approach to natural-appearing periorbital rejuvenation
If there is a facial rejuvenation surgery that is over-recommended and often overdone these days, it is without question the browlift. Look no further than the celebrity photo magazines for pictures of stars who look like they have just sat down on a plate of tacks. The goal of aesthetic plastic surgery should be to make a person look better and more youthful, not merely different, and certainly not as though one is perpetually surprised. My goal is to provide my patients with results which appear natural, and an unnatural-appearing brow is a dead giveaway that a person has had facial plastic surgery.
I rarely see a patient that has such significant brow descent that I recommend elevation of the entire brow. However, I frequently see browlift patients for whom conservative elevation of the lateral brow produces a more rested, bright, and even elegant appearance. This is very easily simulated with gentle upward traction on the skin of the lateral forehead – if you feel that this may apply to you then try it in the mirror and the improvement will be quite obvious.
A youthful, feminine brow rests above the level of the orbital rim, which is the upper margin of the bony socket in which the eye resides. An aesthetically pleasing brow is somewhat arched laterally, and the lateral end or "tail" of the brow is higher than the medial end. It is quite common for the female brow to assume an essentially flat or horizontal orientation as a person ages.
If the skin and soft tissues lose enough elasticity with age and sun exposure, the lateral brow may even descend to a level below the orbital rim, producing a tired or even 'surly' appearance. The medial brow is relatively fixed in position and in most cases does not descend much, if any. In years past, a browlift surgery required an incision across the top of the head, from ear to ear. This was replaced in the 1990's, for most surgeons, by the endoscopic browlift, which allowed the same procedure to be performed through small incisions just behind the hairline.
While I used endoscopic browlift techniques for several years to treat brow descent, more recently I have transitioned to performing a limited incision lateral browlift that does not require the use of an endoscope. The relatively short incision is hidden behind the temporal hairline, and no incisions are required in the scalp directly above the eyes. The advantage is as follows: this approach allows me to not only redrape the lateral brow (conservatively!) in a higher position, but it also allows me to reposition the skin and soft tissues of the lateral periorbital area in an upward direction, producing a more complete rejuvenation of the periorbital area. Additionally, through this same incision I can perform suspension of the midface (cheek) if that is part of the surgical plan.
Rejuvenation of the brow by means of a lateral browlift will also, in most cases, improve the appearance of the upper eyelids. When the lateral brow is repositioned above the orbital rim, the vertical elevation may eliminate the appearance of wrinkled or 'crepey' upper eyelid skin. If the lateral upper lid skin is 'hooded' over the lateral corner of the eye, this improves as well. While upper blepharoplasty (upper lid skin excision) is often performed in concert with a lateral browlift, for many patients the upward positioning of the brow eliminates the need for skin excision.
Treatment of ‘Frown Lines’
The frown muscles (aptly named the 'corrugator' muscles) which create vertical frown lines between the eyebrows can be removed at the time of a browlift. This can be done endoscopically, through small incisions behind the hairline directly above the frown lines, or through an upper lid incision if upper blepharoplasty is being performed. Many patients undergoing this procedure have enjoyed the effect of BOTOX injection in this area and desire a permanent correction of vertical frown lines. In some cases I perform corrugator muscle removal alone for patients that do not have (or are not troubled by) descended brows.
The Male Browlift
As opposed to the female brow, a man's brow is aesthetically acceptable at, or even slightly below, the orbital rim. The male brow may or may not be arched laterally, and most commonly it is relatively horizontal in orientation. In cases where the male brow has descended well below the orbital rim, and the upper lid tissues appear heavy and redundant, a browlift can be an effective means of rejuvenating the upper third of the face. A great deal of care must be exercised, however, to avoid overdoing and thereby feminizing a male brow.
Although men are much less often good candidates for browlifts than women, endoscopic or trans-blepharoplasty removal of the corrugator (or vertical frown line) muscles is as applicable to males as it is to females, to permanently soften or completely eliminate vertical frown lines between the eyebrows.