Brow drooping or brow ptosis occurs when the effects of aging cause deflation of the soft tissues under the skin, and gravity pulls the deflated tissues down. This drooping of the brows often causes the appearance of excess upper eyelid skin (dermatochalasis), and prompts many patients to seek blepharoplasty (eyelid lifting surgery). While in many cases, patients do have excess or drooping upper eyelid skin, the contribution of the brows to this appearance is often overlooked by patients and physicians. If the problem is not addressed and only upper eyelid skin is removed, the brows can be even further pulled down, exaggerating the problem.
Brow lifting can be done with many different techniques -- each has its benefits and drawbacks.
Internal Browpexy:
The most simple method includes placing supporting sutures under the brow tissue and fixating those tissues back down to the brow bone in their normal anatomic position. This is done through an eyelid crease incision, so the scars are well hidden, and can be easily done in conjunction with a blepharoplasty. The downside to this technique is that it is not a powerful lifting surgery. It is meant to support the brows in a natural appearing way rather than lift, and provides a counter-balance to the effects of gravity on the brow. In addition to the relative lack of external scars, this procedure can also be done in the office or under light sedation in a surgery center. This means that the down time is similar to that of a blepharoplasty with minimal pain, bruising, and swelling.
Direct Brow Lift:
This procedure is also simple and can be done in the office setting or under light sedation. It has powerful lifting ability and involves making a small incision at the top of the brow. Skin can be removed and the loose tissues can be fixated to the bone through this incision. Because skin is removed, the brows can be elevated and placed in a higher position with anchoring sutures to the underlying bone. The downside to this procedure is that the small incisions are made just above the brow. Because there is not a natural crease above the brow, the incision is hidden in the brow hairline. Although the incisions heal well with minimal scarring, patients who have thinning brows may have a more visible scar than those with full or heavy brows.
Pretrichial Brow Lift:
This technique also has powerful lifting ability because like the direct brow lift, skin can be removed and the brows can be elevated by anchoring the loose tissues to underlying bone. The difference here is that the incision is made in the forehead hairline, so that patients are easily able to hide this incision line. Because pretrichial brow lifting often involves a larger incision and more dramatic lifting, patients are usually most comfortable having this procedure under light sedation in an outpatient surgery center. The recovery is relatively rapid, with minimal pain, bruising, and swelling. The downside to this procedure is that the skin removal can lower the hairline slightly, so the pretrichial lift is often used in patients with a naturally higher hairline.
Endoscopic Brow Lift:
This popular technique for lifting brows involves making small incisions in the hairline. The incisions are small and usually undetectable after healing because the surgery is performed using the assistance of a microscopic camera to aide in visualization. Patients often choose this method because it combines a powerful lifting ability with an exceptional cosmetic outcome.
As this is a more technically difficult procedure, it requires specialized equipment and physician training to be done well. ASOPRS trained oculoplastic surgeons such as Dr. Annunziata and Dr. Becker have extensive training in endoscopic brow lifting, and are uniquely qualified to perform this procedure skillfully with exceptional results.
Each patient is an individual and techniques should be selected based on patient needs with appropriate tailoring. Ask your physician which technique is right for you by making an appointment today.
