What are the signs of forehead aging?
Brow Drooping
Youthful eyebrows are typically located at the level of the brow bone. However, with aging, the scalp and forehead skin gravitate downward onto the upper eyelid. Much of the heaviness and tired appearance of the eyelids is actually the drooping brow.
Upper eyelid skin excess
The drooping brow skin weighs on the upper eyelids and causes the skin of the upper eyelids to drop down toward the eyelid margin. The drooping brow skin gives the appearance of extra eyelid skin. The skin excess can be elevated with a brow lift or be removed with a blepharoplasty. For many women the upper eyelid can be rejuvenated by lifting the forehead. However, a separate removal of eyelid skin (blepharoplasty) or the combination of blepharoplasty and the forehead lift may be most effective to create a youthful upper eyelid.
Transverse Forehead Wrinkles
The transverse wrinkles across the forehead are caused by forehead muscles elevating the eyebrow and forehead. When the eyebrow skin weighs on the eyelid, it obstructs vision and gives a tired feeling and appearance. The weight on the eyelids will subconsciously cause you to lift your brows using the forehead frontalis muscles. When the muscles lift your brow, the forehead wrinkles transversely. Surgical browlift reduces forehead wrinkles because the muscles don’t have to elevate the brow.
Vertical Glabellar Wrinkles (between the eyebrows)
Vertical folds between the eyebrows are caused by contraction of the squint muscles between the eyebrows. The corrugator muscles pull the middle of the eyebrows downward and centrally. This gives the appearance of scowling and squinting. These wrinkles and the low position of the central eyebrow can be surgically improved by removing the muscles. The vertical wrinkles between the brow and the facial expression of scowling and anger is diminished by removing the corrugator muscle.
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Before & After
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How is browlift surgery performed?
Brow lift surgery has 3 variations: minimal incision endoscopic, coronal scalp incision, and forehead and hairline incision. They are all safe and effective. These methods vary in the position and length of the incision and the effect this has on the height of the forehead.
Endoscopic forehead lift
An endoscope functions as a viewing device. It consists of a tubular probe fitted with a tiny camera and bright light, which is inserted through a small incision; and a viewing screen to magnify the transmitted images of the body's internal structures. The surgeon watches the screen while moving the tube through the surgical area. A second small incision is used for surgical instrument access to perform the surgery.
The endoscopic method is the most commonly used method. It does not change the scalp or hairline. Because it involves smaller incisions, endoscopy leaves very minimal scarring. To insert the probe, only a few incisions less than one inch long are required. Shorter incisions also reduce risk of sensory loss due to nerve damage. Also, bleeding, bruising and swelling may be significantly reduced. The position of the scalp and forehead is maintained by fixation devices. These absorbable devices hold the forehead and scalp in the desired position.
Coronal Forehead lift
An incision is made across the top of the head from the front of one ear to the front of the other ear. The forehead and brows are elevated and excess skin is removed. The flap is then sutured. This was the original method that required a long incision across the entire scalp several inches behind the hairline. The lifting is achieved by removal of a strip of skin (1-3 inches) that elevates the forehead by the tension created by tissue removal.
This method elevates the frontal hairline and therefore is generally selected for individuals with a very low hairline who wish to have a higher forehead.
Frontal Hairline Forehead lift
- This method requires an incision along the junction of the frontal scalp hairline and the forehead skin. A segment of forehead skin is resected to create tension and elevate the forehead.
- This method is used for individuals with an excessively tall forehead.
- The effects of brow lift make you look younger, refreshed and alert
- Elevate the eyebrows (and change shape if desired)
- It is important to determine an attractive height and position of the eyebrows. There is an opportunity to shape the eyebrow position to give a more youthful elevated position. However, too much lift causes a startled appearance.
- You can test for the most desirable position of by standing in front of the mirror, lifting the eyebrow and examining the appearance of different brow positions and the resulting improvement of the wrinkles and the upper eyelid skin excess.
- The brow can be lifted to various angles and heights. Often the outer edges are drooping more than the inner side.
- The eyebrow position can also be evaluated with computer imaging.
- Lift the eyebrow skin off of the upper eyelid to help show the underlying contour of the upper eyelid.
- Remove or reduce the wrinkles between the eyebrows and nose that are caused by scowling and squinting and nose wrinkles.
- Minimize the transverse wrinkles of the forehead caused by unnecessary lifting of the eyebrows.
What to expect after surgery
- Vision may be blurred for several days.
- Pain is minimal and there may be a feeling of a tight band
- Swelling and some bruising around the eyelids should subside within a in 1-2 weeks
- Sutures are generally removed at about one week
- Women can use eye cosmetics two weeks after surgery.
- You can proceed with your normal daily activities within 1-2 weeks
- Partial recurrence of the wrinkles of the brow can occur months later
- Partial recurrence of eyebrow droop can also occur months later
- You may have temporary numbness or tingling of the forehead and scalp
- Very rarely there is temporary weakness of the muscle that lifts the eyebrow
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