Three Things to Know About Browlifts.

Have you ever been asked why you are angry or tired, even when you’re not? A common reason may be your brows have descended with time—making you look angry and tired. This can be very annoying, especially if people continuously bring this up. But it highlights how important our facial features are, because people make snap subconscious impressions based on how you look. The good news is there are effective options to treat this.

First, it’s important to carefully examine your face to find out why you look tired and angry. A common cause is due to simple wrinkles formed by subconscious over activity of the frontalis and corrugator muscles. These create those unattractive angry “11’s” between your brows and the deep forehead wrinkles. Another possible reason may be bags under your eyes, or excess upper eyelid skin hooding. And finally, it may be because your brows have slowly descended to a lower position. The ideal brow in a woman should be slightly above the orbital rims and should have a gentle feminine arch. Where the height of this arch is debated among experts. Some believe the arch should be at the level of the lateral limbus (ie the edge of your iris), while others believe it should be at the level of the lateral canthus (ie the outer edge of your eye). In my opinion, I feel most attractive brows have the arch more laterally. If the arch is over the lateral limbus, it may convey a more surprised or sinister look. However, as in all things in our field, every patient’s face is different and so the features must be examined within the context of the other facial features. I’ve seen beautiful models with their arch more medially. For men, the brows should be just at the orbital rims, and should have less arch to them.

Second, after the diagnosis is made, you will consider your treatment options. If the reason is due to wrinkles from the corrugators and frontalis, then Botox or Dysport are excellent treatment options. These are super safe and effective, with the only downside being the need to repeat every three to four months. If the cause is upper eyelid skin hooding or lower lid bags, then treatment options include blepharoplasty or fillers in some cases. With brow ptosis (or droopy brows), the only effective option is surgery. Botox can achieve a very slight brow lift (ie around 3 mm), but this typically won’t solve your problem.

So how is a browlift performed? There are several ways to do a browlift. The most popular technique today is the endoscopic browlift. The advantage is you only get small incisions hidden within the hair and good brow lifting can be achieved. There are different ways to fixate your brows in their new position. These include using a bio adhesive (or glue), using dissolvable tacks that are drilled into your skull, using sutures with or without a drilled tunnel into your skull, or using temporary drill posts. Each option has its advantages and disadvantages. I like using the BioGlue because it avoids the rare risk of accidental improper drilling into vessels or brain. Some patients may not be good candidates for an endoscopic browlift. The most common scenario here is a patient with a high hairline. The high hairline makes it harder to use the endoscopic instruments. Plus, the hairline may be raised even higher, which patients don’t want. For these patients, I recommend a trichophytic browlift—where direct incision is made within the hairline. This creates a larger scar, but allows excellent exposure and elevation. The scar actually heals very well if done correctly. For men who are balding, usually using preexisting deep forehead wrinkles is a good technique. A coronal approach—where the entire scalp is mobilized with large incision—is rarely used today. The recovery after a browlift is usually not very painful. You may have a temporary pressure dressing the first night. There will be some swelling, but that resolves within the first week. Facial nerve injury is a rare complication. You should also expect scalp numbness that will last many months.

The last thing to bear in mind is to make sure you consult with a board-certified surgeon with experience performing browlifts. Facial plastic, plastic, and oculoplastic surgeons are all trained to do this procedure. Meet with your surgeon to make sure all your questions are answered and that you feel comfortable with him or her.

For more information about browlifts in San Antonio contact Dr. Kenneth Yu Facial Plastic and Reconstructive Surgery. We are a qualified team of experts serving the San Antonio, Texas area. To schedule a consultation, please call our Concierge Patient Coordinator at (210) 876-6868 today.