The eyebrow region needs to be critically assessed with relation to the upper eyelids, forehead and hairline. There are multiple factors at play which is why it is important to be formally assessed by a qualified plastic surgeon for an accurate assessment.
A browlift when required is often performed in conjunction with other procedures such as a facelift, midface lift or upper blepharoplasty. It is definitely a less common operation in current times as there is a trend to non-operative measures to treat ageing in the upper third of the face. A traditional browlift addresses the eyebrow position, glabella frown lines and the transverse frontalis forehead lines. There are multiple different approaches and methods of fixation which are discussed further below. The fundamental corrective procedures of a browlift include –
- Elevating the eyebrow and excision of skin +/- hair to change the hairline
- Division of the frontalis muscle responsible for transverse forehead lines
- Division of the procerus and corrugator muscles responsible for frown lines
Botox can be used to subtly change the position of the brow and improve the shape of the eyebrow aesthetics. A combination of paralysis of the muscles that either elevate or depress the brow can either drop or lift the eyebrow respectively. The most common combination is to lift the outer half of the eyebrow and/or depress the inner half in order to give a higher arched brow laterally.
Lateral Temporal Browlift
A common approach, the lateral temporal lift places an incision about 2 inches in length inside the hairline of the temple region so it is almost completely hidden. Dissection is then done down to the outer orbital rim and the lateral eyebrow only is elevated. It does not address the inner eyebrow and does not involve dividing any muscles.
Bicoronal Open Browlift
This is the standard “old school” browlift which has stood the test of time. It involves an incision either just in front or behind of the hairline which goes right across the top of the head from one ear to the next. The advantage is that it can address all of the features listed above and has good long term results. It does result in permanent numbness of the scalp behind the scar.
Touted as a minimal scar browlift endoscopic browlift is still commonly performed but less so than previously. It involves 4-5 small incisions in the hairline across the scalp and then suspension of the eyebrow. Some have a concern about the long term durability of the results.
Methods of fixation
Methods of fixation to fix the eyebrow in place to the deeper unyielding structures (bone or temporalis fascia include –
- Suture fixation
- Bone tunnels
- Endotine – a small dissolvable prosthesis with barbs.