Brow Lift Palo Alto
THE MANY DIFFERENT BROW LIFT OPERATIONS
The term brow lift encompasses many different operations. The trick is to pick the right operation for the right patient. USUALLY A BROW LIFT AND A FROWN CORRECTION ARE DONE AT THE SAME TIME. Many different terms all mean the same thing including browlift, frown correction, forehead lift, and eyebrow lift.
There are multiple different ways to raise the brow and address the central frown. These include the corona lift, the hairline lift, the endoscopic lift, the eyebrow crescent lift, and the brow tacking procedure. We will discuss all of these.
The coronal procedure is a procedure rarely used these days. In this procedure an incision is made from ear to ear and the forehead is lifted via removal of a large excision of hair bearing scalp. In view of the hair loss, no one wants this procedure anymore and rightly so. Nevertheless it works for a person with loads of hair and a very low hairline. The incision hides well and the procedure does work. There is numbness over the scalp but this subsides with time.
The hairline incision is just that, an incision along the hairline in which a section of forehead skin is removed. The hair is not disturbed. This has a quite direct effect on the brow and allows easy access to the frown. This procedure works well for the person with a very high forehead because a section of the forehead skin is removed. The brows come up. The incision is a worry but generally hides very well. After this procedure, patients universally feel they have more hair and a better distribution of their hair. The feeling of more hair may be the most appreciated factor.
The direct excision eyebrow lift is okay, and works, but the incision at the upper border of the eyebrow often shows a bit. This is really the only way for a totally bald male to do a brow lift. The frown can be addressed through the direct excision site. Patients must be cautioned the incision will show for 3 or 4 months but eventually is quite good. It is direct and simple and works well. The frown can be approached easily via this excision site.
The tacking of the brow is done via the upper eyelid incision. This works if one just wants a tiny brow lift but rarely is it very effective. It can be done at the same time as the upper eyelid surgery. It can be done if only minimal results are desired.
The last procedure to be mentioned is universally the best. That is the endoscopic brow lift. The procedure is done via tiny incisions x 5 in the scalp and no hair is disturbed. Through these incisions, a small instrument is placed to lift up the scalp skin. The scalp skin is extensively freed up down to and including the orbital superior, lateral and medial rims. Once freed up the forehead and the brows are free to move up and they do move up. Through the endoscope (a TV camera on the end of a tube) the surgeon sees and can reduce the frown and release any periosteal attachments holding the brow in place. At this point the brow is elevated and held in place with tiny pins that are removed in 10 days. At this point the brows are stuck in their new position and stay up for years to come. Since the frown muscle is removed and altered, the frown is subdued. The hair is not disturbed and the tiny incisions are closed with tiny sutures. This is the best of all brow lifts.
This procedure can be done awake or asleep but it is nice to be asleep. There is little postoperative discomfort. There can be some forehead swelling and bruising but this passes in a week or so. The endoscopic brow lift is truly one of the GREAT plastic surgery procedures. This can easily be accomplished at the same time as a facelift and eyelid operation. It is perfectly safe to combine other procedures including the upper eyelid blepharoplasty.
There can be confusion about which is the best method for each patient. A surgeon with vast experience can explain to each patient the relative merits of each procedure for that patient. If there is doubt about the best go with the endoscopic lift. No bridges are cut and there is virtually no down side and all gain. The exceptions are the female with the high forehead who must have a hairline excision and the totally bald male who must have the direct above the eyebrow excision.
In conjunction with a facelift, I often perform forehead surgery (forehead / frown procedure ) to elevate drooping brows, to give an open, alert upper eyelid, and to soften frown lines. Advances in forehead surgery include the use of mini incision endoscopic surgery, employment of “detection defying” hairline technique, and improved versions of the coronal technique. Because each approach has merit, the important issue is to match each patient with the technique that is best for him / her. A hairline incision approach works well if the patient has a high forehead with receding hair. When I use the hairline approach, I elevate the brows and bring the scalp hair forward. If the patient has a narrow forehead, I use the endoscopic procedure. Clearly, the “cookbook” technique has no place in the individuality of plastic surgery. My job is to select the correct technique for each individual patient to ensure the desired results.