The brow has always been considered one of the most challenging areas of the face for plastic surgeons to treat. As a result, there are many different surgical brow lift techniques that all try to address the brow/forehead in different ways, and these methods are constantly changing. Historically, the brow was rejuvenated with a “coronal incision” made way back in the hairline. This was a good technique for many years, but it would sometimes tend to result in a visible scar or “bald” spots in the hairline (temporal area), as well as pull back the forehead in a way that created an “elongated forehead”. Largely, that technique has fallen out of favor – there are still some surgeons who prefer that technique, but it is a big surgery with a large incision and potential risk for nerve injuries and/or other complications.
The “endoscopic brow lift” became popular in the early 1990s, and I was lucky that one of my mentors, Dr. Tom Biggs, was of the first plastic surgeons to become experienced in the technique. It is an elegant method anatomically, and the advantages include a minimal incision hidden in the hairline to provide access to the camera; however, with this approach, most of us would notice that the brow didn’t lift very much, and there was a high degree of recurrent brow ptosis (drooping). Many plastic surgeons have gone away from this technique for this reason, as well as the need to perform the procedure in a larger medical center or hospital simply because of the equipment usually necessary to do it endoscopically.
When I started my practice in 2005, I regularly performed endoscopic brow lifts. In some cases, I felt we needed something “more” than this to “pull up” the brow laterally. BOTOX® Cosmetic really was a game changer, and the “BOTOX® brow lift” was so effective that it drastically reduced the need for surgical brow lifts in my practice. I still do an occasional endoscopic brow lift, but now I am very excited about the lateral subcutaneous brow lift that I can perform in the office with a minimal valium and only local anesthesia.
The lateral subcutaneous brow lift really addresses the issues that bother most patients in a better, more effective way. Most female patients are really bothered by the “tail” of the brow that has fallen over time, and when you simulate a skin lift to correct this, you can see how the lateral subcutaneous brow lift can be effective. This technique involves a small, 4-5 cm incision well-disguised into the hairline, as well as the removal of some of the “loose skin” to achieve a real lift. Most women also want improvement around the eyes, which may include blepharoplasty performed in conjunction with the brow lift. This can provide a surgical option to patients who may be tired of the repetitive need for frequent BOTOX® injections. Also, some patients have too much laxity for BOTOX® Cosmetic to really be effective, anyway.
Men also have brow concerns, and although most men don’t want an “arched brow”, we want a nice, straight brow along the orbital rim (bone above the eye socket) and not below it, the latter of which can affect vision. This same lateral subcutaneous brow lift can be really effective in male patients, as well. However, in some male patients with severe male pattern balding, we may select a “direct brow lift” involving a small incision hidden just above the eyebrow.
Ultimately, what I like about the lateral subcutaneous brow lift is that it’s a simple, in-office procedure that truly addresses the brow in an effective way – all without an extended recovery or the need to go to a hospital for surgery.
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