One of the many features of facial aging is changes in the upper face or forehead. As the forehead undergoes aging, horizontal wrinkles appear and the eyebrows descend lower. A lower position of the brows is medically known as brow ptosis. Brow ptosis and excess upper eyelid skin, if severe enough, may even impede on one’s vision.
As everyone has differently shaped and arched forms to their brows, the brows may drop down unevenly. Sometimes it is the inner or medial aspect of the brow that is too low…or it may be the outside or lateral part of the brow that sits below the prominent brow bone. Or it may be that the entire brow has fallen. In most patients, however, the outer or lateral third of the brow ages first and often the most. Aesthetically, eyebrow shape is more significant than height and eyebrow shape is highly affected by the level of the lateral brow.
For brow ptosis, a forehead or browlift procedure creates a rejuvenating effect. There are different methods of browlifting which can be done either through long open scalp or hairline incision or endoscopically through a few small scalp incisions. Browlift surgery, however, usually lifts the medial brow quite successfully but is weakest at raising the lateral brow. This is because the scalp incision from an open browlift tails off over the lateral brow area so not as much tissue is removed. In the endoscopic browlift, only the central part of the lift is secured by fixing it to the bone. The part over the lateral brow is lifted and secured to the temporalis fascia which is not as secure as that of bone.
Because of less effectiveness in lifting the lateral brow and that some patients only need to rejuvenate that brow area, the lateral browlift was devised. The lateral brow lift, also known as a temporal browlift uses incisions which are made at the temples behind the hairline. Skin is removed in this area and internal sutures are used to support the lifted tissue so the scars do not become wide afterwards. This is a simple procedure that can be quite effective. There is usually no connecting incision between the two temporal lifts.
The lateral browlift can also deal with folds and small wrinkles in the forehead and the corners of the eyes (crow’s feet). There is also a mild effect of lifting in the cheek area but this is usually fairly minor and one shouldn’t expect too much of a change in this area. Too much lateral brow lifting can produce an exotic look to the outer arch of the brow or a cat look, which is usually not desired by most women.
The lateral browlift may be done alone or as part of other browlifting techniques. It can be part of either an endoscopic browlift or as a modification of a traditional open browlift procedure.
Dr. Barry Eppley
Indianapolis, Indiana