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Originally Published in Alamo Today

Our natural aging process lets gravity accelerate the descent of one of the most prominent features of our face, our brow. Take a moment to look at yourself in the mirror.

Are you using your forehead muscles to hold up your brow?

Do you see horizontal lines on your forehead?

Do you have to hold your forehead up in order to see?

Patients often mistakenly relate these issues with the need of needing their eyelids rejuvenated (blepharoplasty). However, these issues are not resolved with the pulled back look of a blepharoplasty alone. What is needed is a complete repositioning of the brow to a natural, youthful position...a brow lift.

The brow line for women tends to be proportionally higher on the face and is naturally arched – positioned just above the rim of the upper orbital bone. In men, the brow line is less arched and is positioned closer to the rim. As we age, the change from a youthful position of the brow presents itself as forehead wrinkles, as a subtle hood, or as excess skin over the eyes or on the brow between the eyes.

A sagging forehead places excess tissue at the eye brow line and just above the eyes. This gives the face a tired, frowning, and often times, angry look. This sagging tissue can actually also impair vision. Repositioning the tissues back to their natural location eases this aged appearance and opens up the eye region of the face.

When evaluating the face during a consult, I look at and make note of the mor- phology/anatomic features, then evaluate those changes resulting from the aging process. Morphology refers to the shape or form of anatomy. It is the morphol- ogy of the face, rather than the anatomy itself, that we change through aesthetic surgery. As a highly trained Board Certifi ed Plastic Surgeon, I understand the artistry behind morphology while also possessing the detailed knowledge of the related anatomy essential for superior aesthetic surgery results.

Depending on age, there are a variety ways to achieve a brow lift. Younger patients can have carefully placed Botox to temporarily lift the eyebrow and smooth the forehead. However, expert placement of Botox used for this purpose is required to ensure the eyelid does not inadvertently droop. Fillers such as Sculptra, Juvederm, Radiesse, and Restylane can also be used to provide a minor lift to the brow. These treatments can last anywhere from four months for Botox to two years for Sculptra or Radiesse. Additionally, recent advances in Laser technology allow treatment that can reinvigorate the collagen in the skin, providing a short term natural looking lift to the brow.

When we start looking at longer-lasting results available through the use of surgical options, there have been signifi cant technological advancements in the procedure which have improved effectiveness while ensuring a more natural look post-surgery.

Surgical brow lifts are performed either “open” or “closed.” In most cases I prefer to perform a closed, or endoscopic, brow lift. The endoscopic brow lift procedure utilizes small incisions in the hairline and a tiny microscope to guide the surgeon during the procedure. Post-operative recovery time is shorter and results are more natural looking. An open brow lift involves a longer incision at the hairline or scalp, allowing for removal of forehead tissue and excess skin when necessary, and tends to be more appropriate for a patient with a high forehead. A closed brow lift is appropriate for patients with a moderate or low forehead as there is generally little or no skin removed with a closed procedure.

Whether open or endoscopic, the brow lift procedure is the same. The tissue above the forehead bone is released and re-positioned. Small muscles which cause frowning are weakened or removed. The tissues are then re-attached to the bone using sutures, screws, or, my preference, endotine technology. The absorbable natural endotine plate holds the brow in its new position after surgery and during the healing process. Endotine technology enables the soft tissue of the forehead to be repositioned and fi xed into place so it can heal as the surgeon intends. An endotine is made of the same substance as dissolvable sutures and is ultimately absorbed by the body.

Many of my patients elect to have a blepharoplasty (eyelid surgery) at the same time as the brow lift. A blepharoplasty removes the sagging skin which develops around the eyes. We target the upper eye, lower eye, or both. Laser skin resurfac- ing around the eyes is also often incorporated with the brow lift to rejuvenate the eyelid skin and to eliminate crow’s feet.

The brow, eyelid, and face are best rejuvenated from the top down. That means we evaluate the brow and move lower to the eyelids, cheeks, chin, and neck when discuss- ing your goals for a natural, aesthetic and lasting change. It would be my pleasure to consult with you on how the aesthetic benefi ts of a brow lift may be the change you are looking for... back to a more natural and youthful facial appearance.

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