Men are more prone to eyebrows dropping down with age due to their often heavier foreheads. Fortunately, a low brow in a male is much more tolerable than in a woman. Male brows also have a different shape than a woman’s, being less arched and more at the level of the brow bone. When the brow gets low enough, combined with extra skin in the upper eyelids, the resultant facial appearance can look very tired, sad, or even angry.
Brow lifting in men, however, presents issues that are different from most women. The lack of hair or a poor hairline eliminates the use of many traditional open brow lift surgeries that are so effective. The male forehead skin is often much thicker and the forehead muscles much stronger than a female’s. This eliminates the possibility of the minimally-invasive brow lift procedures such as suture suspensions or threadlifts. This leaves the options of either endoscopic brow lift approaches or direct brow procedures. In my experience, the endoscopic browlift is still of more limited usefulness in many males due to their hairlines. Even small scars, if visible, are not a good trade-off in most cases.
I find the direct brow lift procedures, going through the upper eyelid incision, a good compromise. Most men are going to need an upper blepharoplasty anyway so no additional scar burden is incurred. Either suturing the brow up from underneath to a higher position on the frontal bone or using the resorbable endotine forehead device provides some modest brow elevation that is subtle but evident. It is easy to perform and adds little time to an upper blepharoplasty procedure. It is limited by the location of the supraorbital nerve at the inner aspect of the brow so the inner 1/3 of the brow is often not changed much. But injury to the nerve is not worth trying to get a few extra millimerters of lift in this area. Often a slight bulge will be evident after surgery just above the brow where the underneath dissection has stopped but no patient of mine has expressed any concern about it to me.
Fortunately, men want a more subtle change anyway, particularly in the brow area. And either the endoscopic browlift or the direct brow lift does just that.
Dr Barry Eppley
Indianapolis, Indiana