Brow and Forehead Surgery

As we age one of the most noticeable features is the descent of the eyebrows. The female eyebrows are normally arch shaped and above the level of the bony rim above the eyeball. The normal male eyebrow is usually at the level of the bony rim. In both males and females, aging causes the eyebrows to droop and overlap the eyelids.

Many people feel that they need eyelid surgery because they have droopy upper eyelids. In actuality, they may need their forehead and eyebrows suspended back to their youthful position. If excess eyelid skin is removed in a patient with sagging brows, the condition can actually be worsened, because the tightening may cause the brow to descend even more. For this reason, it is important for the surgeon and patient to fully realize the contribution of droopy brows before removing eyelid skin. If the patient has droopy brows and excess eyelid skin, then they may be addressed at the same surgery.

Some surgeons may fail to evaluate brow position and if too much eyelid skin is removed, a brow lifting procedure may be impossible in the future. For this reason, evaluation of the brow position must be considered.

Elevating the eyebrows, a forehead and brow lift smoothes the horizontal forehead wrinkles and decreases the activity of the muscles between the eyes and on the forehead that are responsible for scowling.

Older methods of brow and forehead lifting require large incisions that extend across the entire scalp. These surgical approaches may lead to scalp numbness and hair loss. The new methods of brow lifting are done with endoscopes or conservative incision technique. This is the same type of technology that is used for arthroscopic knee and shoulder surgery. Several small incisions are placed within the hairline and the endoscope is inserted under the scalp and the surgeon can visualize the tissues of forehead and eyebrow. Using special instrumentation, the surgery is performed without any large incisions and the recovery and complications are decreased.

Endoscopic forehead and brow lifting is usually performed in the office surgery center environment with sedation. Recovery is about 7-10 days.

The above patient is shown before and TEN YEARS after endoscopic brow and forehead lift.

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This patient is shown before endoscopic brow and forehead lift (left), In 2002, one month after her endoscopic brow and forehead lift (center) and in 2009 (7 years later) after endoscopic brow and forehead lift.  Her result has remained stable over this period.

Mini Open Brow Technique

Although endoscopic brow and forehead lift is an excellent and conservative procedure, it has some downsides. This type of brow lift will cause an elevation of the hairline. This may not be a problem for some patients, but for others it is not a desirable look. In addition, with endoscopic techniques, deep and aggressive dissection must take place which can increase pain, bruising and recovery. Finally, the brow must be fixated in some manner requiring the drilling of holes in the patient's skull and placing some type of hardware. Although the endoscopic technique is an accepted procedure, many patients will develop relapse and the brow will droop again after surgery.

All of these problems can be alleviated by the mini open brow technique. This surgical approach utilizes a special incision know as a trichophytic incision. This incision is made just behind the hairline and done in such a manner that the hair will regrow through the incision scar. This technique is done only under the skin as opposed to the deep tissues like other techniques. The forehead is not elevated and the hairline can actually be lowered with the mini open brow technique. Since this is a skin incision technique, no holes are drilled in the skull and no hardware is required. Finally, this technique is very stable and the results can last longer than any other type of brow lift. The mini open brow technique should not be confused with the older type of coronal brow incisions. These older techniques required extremely large incisions on the scalp and very deep dissection. That is not the mini open brow technique. The mini open brow technique can be thought as a facelift for the brow as it is a very similar technique.

The mini open brow incision is made just behind the hairline. This specially designed incision is placed in the center of the forehead just behind the hairline so the final scar is hidden.

This is the incision 10 weeks after surgery.

This photo shows another incision 10 weeks after surgery, note the new hair growth through the scar.

This image shows the patient before (left) and 90 days after mini open brow lift surgery. The hairline is natural and the scar is fading.

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The patient's hairline scar is shown before and after mini open brow lift

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The patient's hairline scar is shown before and after mini open brow lift

The longevity of the mini open browlift is very stable. The patient shown below is shown 2.5 years after the procedure Click to enlarge).

Both the endoscopic and the mini open brow techniques are excellent options and Dr. Niamtu can discuss the relative advantages for each specific patient.

Dr. Niamtu and Brow Lift Education

Dr. Niamtu lecutres frequently on brow and forehead lift surgery.  The photo below shows Dr. Niamtu demonstrating endoscopic brow lift at the University of St. Louis Cosmetic Facial Surgery Course cadaver lab.  Also shown is course director Dr. Mike Nayak.

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The above brochure is from a multispecialty cosmetic facial surgery course at the University of St. Louis in July of 2006 where Dr. Niamtu lectured on eyelid and brow surgery.

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The above brochure is from a multispecialty cosmetic facial surgery course at the University of St. Louis in February of 2007 where Dr. Niamtu has been a regular lecturer on eyelid and brow lift techniques.