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 smooths the horizontal forehead wrinkles and decreases the activity of the muscles between the eyes and on the forehead that are responsible for scowling.


Mini Open Brow Technique (Transfollicular Brow Lift)

Most types of brow and forehead lifts can elevate the hairline, fail to address deep forehead wrinkles and may require screws, holes or plates in the skull to maintain the elevation.

Figure 18All of these problems can be alleviated by the mini open brow technique. This surgical approach utilizes a special incision know as a transfollicular or  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 hairline is not elevated and 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. In addition, many surgeons feel that this technique is the most stable type of browlift and the results can last longer. 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 to facelift surgery where excess skin is removed to increase longevity of the operation.

The basis of this technique is a precision incision that allows the hair follicles to regrow through the scar.  This is called a transfollicular or trichophytic incision method.  The result is an incision scar that is barely noticeable.  The diagram below illustrates how the hair follicles grow through the precision incision.As the healing progresses, the hair regrowth becomes evident which camouflages the scar.  The picture below show a patient’s hairline before mini open brow lift and 8 weeks after surgery with new hair growth surrounding the scar.

     

Mini Open Browlift Recovery and Results

10 weeks after surgery

This above incision 10 weeks after surgery.

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3 months after surgery

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This is a mini open brow lift incision shown at 3 months.

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90 days after surgery

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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Full recovery

The patient below is shown before and after mini open brow lift .

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This image shows the before and after hairline of the same patient as pictured to the left.

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Lasting results

This patient shown before and after “mini open brow” lift performed by Dr. Niamtu

The hairline is shown in the same patient as the picture on the left before and after “mini open brow lift”

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2.5 years after the procedure
The longevity of the mini open browlift is very stable. The patient shown to the left is shown 2.5 years after the procedure.

 

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Mini open browlift with blepharoplasty can restore a more youthful appearance

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


Endoscopic Forehead and Brow Lifting

Brow Lift - endoscopic technique, Richmond VAOlder 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.

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The video below shows Dr. Niamtu releasing tissue for brow elevation using the endoscopic technique.  The tiny camera is placed under the patients scalp and the instruments are inserted through button hole incisions that are hidden by the hair.

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