The endoscopic brow lift is the method of choice for rejuvenative surgery of the upper third of the face. It can revitalise the entire forehead, smooth out frown lines and wrinkles, and restore the position of the eyebrows. A brow lift will also raise and tighten loose skin of the upper eyelid and open up the eyes.
Although the forehead is much less prone to ageing and gravitational descent than the mid and lower third of the face, it is sometimes necessary to include the forehead in combination with eyelid surgeries or a facelift as part of a complete facial rejuvenation.
Since the brow and forehead are close to the eyes, most concerns related to this zone stem from sagging brow tissues that in some way affect the eye area; either by drooping skin reducing the size of the eyes, heavy brows affecting their appearance or by physical impairment of upper eyelid function. The second most frequent concern relates to folds and frown lines in the central part of the forehead, which may communicate a heavy or fatigued appearance.
Reasons for lifting the forehead and brow tissues include reversal of the gradual age-related droop (ptosis) of soft tissue which is a natural process of facial ageing, though more pronounced in some individuals. Secondly, brow lifts can be used to adjust a congenitally low and heavy brow and correct asymmetry (due to conditions such as facial palsy where lack of muscle function will result in an asymmetric sagging of forehead soft tissue).
Forehead and brow rejuvenation
Forehead and brow rejuvenation is customised to suit individual features: lifting of the brow, repositioning of descended tissues, adjustment of skin, and modulation of the muscle function responsible for lines and creases. The forehead, brow and eyes are areas where gentle adjustments can lead to major improvements. A lift of just 1-1˝ cm is often sufficient to open up the eyes and restore the youthful position of the eyebrows.
Forehead rejuvenation usually requires lifting the outer half of the brow, as the mid-section is anatomically more stable and less prone to gravitational descent. A delicate upwards curve of the brow is aesthetically appealing. The overall aim is to position the outer part (end point) of the brow slightly higher than the inner part (the start point) with a gentle arch in-between.
Options for brow lift:
1. Temporary brow lift with botulinum toxin
Botulinum toxin injections in the forehead muscles will temporarily relax the muscles responsible for crease/line formation in the forehead. In addition muscle relaxing injections to the outer part of the orbicularis oculi muscle (outside the eye) will result in a slight compensatory elevation of the brow line of about 3-4mm. Many patients find these mild and temporary improvements sufficient.
2. Brow lift from the upper eyelid (transpalpebral browpexy)
For patients also having upper eyelid surgery, it is possible to provide minor adjustments (stabilisation) to the brow position as an auxiliary procedure. In addition, this technique allows modification of the muscles that create vertical lines in the forehead.
3. Direct brow lift
An excision of skin above the brow is effective in providing elevation, however is rarely used for rejuvenative purposes as it leaves a thin scar at the border of the hair-bearing area. This treatment is occasionally indicated for patients with facial palsy.
4. Open coronal brow lift
Coronal brow lift is the traditional method of forehead lifting through an ‘open approach’. It addresses the forehead through an incision at the border of the hairline which allows for precise repositioning of all soft tissues. However, as this procedure results in a discreet but visible scar, it has largely been replaced by the endoscopic brow lift.
5. Endoscopic brow lift
The endoscopic brow lift technique is minimally invasive, and will produce as efficient a result as an open coronal brow lift, but with faster recovery time and no visible scarring. The procedure is performed through a number of small incisions located behind the hairline using a fibre-optic instrument with a minute camera. This maximises precision and control while the ptotic brow is being released, lifted and tightened.
Dr Sorensen use several points of adjustment from different angels, enabling precise management of the brow’s positioning and alignment. This degree of control means the method is also suitable for correcting asymmetric eyebrows, improving the shape of congenitally low eyebrows or treating pathological drooping foreheads from facial palsy.
Results of this technique are long lasting, aesthetically pleasing, natural-looking and with no alteration to the hairline. For this reason it is Dr Sorensen’s procedure of choice for the majority of patients seeking forehead rejuvenation.
Endoscopic brow lift combined with other facial surgeries
The shape (fullness) of the eyebrow is equally as important as the position (height). For this reason endoscopic brow lift is often combined with fat transfer, eyelid surgery and facelifting, as these procedures complement each other to provide a complete facial rejuvenation.
The endoscopic lift is a gentle, yet powerful technique, providing both aesthetic and functional improvements to the forehead and brow. The best candidates are patients who have good skin elasticity.