As one ages, particularly in men with thicker skin and heavier forehead musculature, the brow will sag. This heavy brow look may be exaggerated by the concomitant contracture of the muscles between the eyebrow, creating a strong ‘eleven sign’ with deep horizontal forehead creases. Once the brow reaches at or below the supraorbital rim, one may consider the concept of browlifting ro help create a rejuvenated look… or at the least help the forehead and brow area appear less tense and more relaxed.
In men, the concept of browlifting takes on some different considerations than that of women. The usual sparse and poor frontal hairlines and hair density usually preclude traditional forms of open browlifting. Open browlifts, while being really what most men need due to its superior ability for muscle management through partial removal, can not be done because of scar exposure from the lack of good quality hair. Also, browlifting will usually lengthen the forehead as the hairline goes back with the lift which is usually an aesthetic disadvantage. For these reasons, many men have to consider an inferior browlift done through an upper eyelid incision (which will have only a moderate effect) or abandon its consideration at all.
For select men, an endoscopic browlift may be a reasonable option. The endoscopic approach offers a minimal scar method which can lift the brows and provide some long-term weakening to the muscles between the eyebrows. It does at the expense of making a longer forehead. As a result, male candidates are those that have a good quality frontal hairline and a short or medium-length forehead…or those that will not be bothered by a hairline which moves higher.
An endoscopic browlift incorporates a periosteal release along the supraorbital rim, subtotal procerus and corrugator muscle resection around the supraorbital nerves, and an entire forehead (epicranial) shift backwards. The lifted forehead is secured by many different effective methods but my choice is resorbable screw (Lactosorb) fixation to the bone underneath the scalp incisions. This is a secure and rapid method that provides frrm fixation as the forehead heals with the screws dissolving away months later.
An endoscopic browlift is not unduly difficult to go through. A head dressing is on for one day only and is removed the day after surgery. One can shower and wash their hair the next day. There will be some mild upper eyelid swelling which will completely go away in a week. Temporary numbness of the forehead and front part of the scalp is normal but the feeling completely returns in four to six weeks after surgery. The forehead muscles, particularly those between the eyebrows, will be weak for awhile. Some movement will always return and the goal is to have about 50% less movement between the eyebrows on a long-term basis.
Dr. Barry Eppley
Indianapolis, Indiana