Brow Lift

Over time, one’s eyebrows may descend due to force of gravity and repeated contraction of the periorbital protractor muscles which include orbicularis oculi, procerus, corrugator supercilii, and depressor supercilii.  A patient with eyebrow descent may give the impression that he/she is tired, angry, or sad.  Brow ptosis may result in apparently redundant skin and hooding of the upper eyelids.  Thus, patients may think that they need a blepharoplasty when they indeed need a brow lift.  If the distance from the pupil to the top of the brow is less than 25 mm, then the patient may benefit from a brow lift.  The proper combination of surgery can be better determined by manually elevating the brow to the proper anatomic position and reassessing the upper eyelid skin redundancy and fat herniation. 

A brow lift may be performed by many different surgical procedures and approaches.  The direct brow lift removes tissue just above the brows and is used in men with bushy brows or patients with severe asymmetric brow droop (paralytic brows) from Cranial Nerve VII palsy.  The mid-forehead lift removes tissue from the mid-forehead and is best on patients with a deep furrow already present.  The pretrichial brow lift excises tissue just anterior to the hairline and is best used on patients with a high forehead who wear their hairstyle in bangs.  The endoscopic brow lift employs an endoscope combined with small incisions placed in the hairbearing scalp to elevate the brow.  The coronal brow lift excises tissue from ear to ear in the hairbearing scalp.

The choice of procedure is individualized based on the patient’s anatomy.  Evaluation of patient anatomy including where to “hide the scars,” forehead height (a high forehead is when the distance from top of brow to hairline with 5.5 cm or more), amount and direction of lift needed, brow shape, anticipating future male pattern baldness, skin texture and quality, and preoperative brow height asymmetry is carefully considered preoperatively.  The incisions and tissue excision may be made from just above the brows up to the hair-bearing scalp.  Generally, the closer the incisions are to the brow, the greater amount of brow lift per millimeter of tissue excised.  Incisions are planned where they will be least conspicuous such as in a current deep wrinkle or in bushy eyebrows.  Placing incisions in a bushy brow, a mid-forehead furrow, or just in front of a hairline (pretrichial) helps to camouflage the incisions, however, they will still be seen.  Incisions in the hair-bearing scalp will not be seen unless male pattern baldness sets in and reveals the scars in the future, and thus must be taken into account.  Incisions in the hair-bearing scalp in the endoscopic brow lift or coronal lift will make the forehead higher (distance from the top of brow to hairline), while incision in the forehead will make the forehead lower.  Patients with thick, oily skin may experience re-descent after endoscopic brow lift and may be better served with a coronal or pretrichial brow lift.  Our surgical approach is customized to the patient’s anatomy and desires.

Eyesthetica is the largest private group in the greater Los Angeles area, whose practice is dedicated solely to oculofacial plastic surgery specializing in cosmetic surgery, eyelid reconstruction, lacrimal and orbital surgery.  We have opened a new office in Torrance to better serve you and your patients.

Eyesthetica                                                                                      Ophthalmic Plastic & Reconstructive Surgery

Oculofacial and Cosmetic Surgery Associates                                                                Orbital and Lacrimal Surgery

Steven C. Dresner, M.D., Michael A. Burnstine, M.D., Melanie Ho Erb, M.D.                               Cosmetic Surgery

Santa Monica          Pasadena               Torrance               Downtown Los Angeles                                                               

310-453-1763         626-564-0004       310-530-9482       213-482-3467                                                                               www.Eyesthetica.com