As we age not only does extra skin and fat weight down our eyelids, but the overlying brows can often contribute to the problem. As the eyebrows fall below the bony rim of the forehead, ‘extra’ skin is created and the upper eyelids get heavier. Both the eyelids and the brow areas narrow the size of the eye making it look older and more tired. While many patients have eyelid surgery for improvement, some may benefit by a combination of eyelid and browlift surgery to create an overall better result.
In understanding browlift surgery, one has to appreciate not only the position of the eyebrow but the existing length of forehead skin (from hairline to brow) and the patient’s hairline pattern and density. These are key elements that help determine which type of browlift may be best for each individual patient.
Fundamentally, there are really two main types of browlifts…open and closed. Closed or endoscopic browlifts are done from back in the scalp and uses two or four small incisions behind the hairline. Cameras are used under the skin to release the brow from underneath and entire scalp/forehead/brow unit is then shifted up and back. In the endoscopic browlift, the forehead usually gets longer and the frontal hairline moves back a bit. Also, if there is a lot of muscle action between the eyebrows, the endoscopic approach is more limited in how much can be removed. As a result, the endoscopic browlift in my hands is very good for those patients that have a short or average forehead length, do not have too much muscle action and deep forehead wrinkles, and whose brow only needs to be lifted a little. Open browlifts are done with an incision and resultant scar either at the frontal hairline or several inches behind it. When the open browlift is done with the scar back in the scalp, the patient with a high forehead has the same problem as the endoscopic browlift. When the incision is placed at the frontal hairline, this is a better choice as the hairline stays put or can even be moved forward or lower. Either scalp or hairline browlifts are better at removing overactive muscle as more muscle can be removed with wide open access under direct vision. (you can remove more when you can see it better)
While some browlifts are done alone, this is unusual as extra eyelid is often present if the brows are low in many patients. Conversely, it is much more common to have eyelid surgery (blepharoplasty) without browlifting. The combination of eyelid tucks and browlifting can make a dramatic difference in how one’s eyes look and the overall facial appearance and impression that it creates. The aesthetic key to browlifting is to not overdo it. No patient wants to have a ‘deer in the headlights’ look. For these reasons, it is important to carefully review beforehand with your plastic surgeon in front of a mirror what amount of browlifting you consider acceptabel and whether it adds enough to the results to justify the effort.
Dr. Barry Eppley
Indianapolis, Indiana