A heavy or drooping brow can lead to hooding of the upper eyelids. Depending upon the severity of the droop, there are effective non-surgical and surgical techniques that can restore the brow and forehead to their appropriate anatomical position.
When there is a mild degree of drooping, botulinum toxins such as Botox can be injected into the brow area to help elevate the brow. This helps create a rejuvenated and refreshed appearance without significant surgery. In addition, dermal fillers such as RHA or Restylane may aid in elevation of the brow and help to rejuvenate the eye area. These dermal fillers can last 8 months to 1 year.
When there is more severe brow drooping, a surgical brow lift is sometimes the best option. There are a variety of methods used to raise the brow depending on the severity of droop, each with their advantages and disadvantages.
Temporal Brow Lift
As we age the lateral, outer brow (temple area) is the first area to droop and creates a hood on the outer eyelid. If the middle portion of the brow is in an appropriate position, a temporal brow lift can selectively elevate the temporal brow to rejuvenate the brow and area around the eye. The incision is hidden in the scalp just in front of or behind the hair line. The brow is then elevated using several internal sutures or another fixation device. The temporal brow lift leads to a rejuvenated appearance and decreases the amount of lateral hooding on the upper eyelid. The temporal brow lift procedure is commonly performed with an upper eyelid blepharoplasty.
Endoscopic, Small-Incision Brow Lift
With the endoscopic, small-incision brow lift, the surgeon creates small incisions behind the central hairline to elevate the entire brow. The surgeon then anchors the brow in the optimal position with Endotines (absorbable fixation device) or sutures. This procedure elevates the central and temporal aspects of the brow and can reduce forehead and glabellar (in between the brow) wrinkles. An endoscopic brow lift is also commonly performed with an upper eyelid blepharoplasty.
Coronal Brow Lift
The coronal brow lift elevates the brow and reduces the severity of forehead wrinkles. An incision is first made at the hairline, across the entire forehead from temple to temple, or ear to ear. The brow is then elevated to the optimal position and the excess tissue is carefully removed. The muscles that create forehead wrinkles are then released leading to a more permanent botox-like effect. The incision is then closed in a layered fashion to allow a more permanent elevation of the brow.
Direct Brow Lift
The direct brow lift is the treatment of choice for patients with heavy brows who are not concerned about their forehead wrinkles. The incision is hidden in the brow line or in the wrinkles of the forehead and excess skin is removed to help elevate the brow. After the healing process is complete, the incision lines are often inconspicuous.
Internal Brow Lift
The brow can also be minimally elevated through the hidden eyelid crease incision used for an upper eyelid blepharoplasty. The brow is elevated using suture and aids in the rejuvenation of the tissues surrounding the eyelids.
Brow lifts can be performed in the office with the use of local anesthetic in some cases, or at a surgery center or in the hospital for cases requiring anesthesia. These are often combined with other procedures such as Upper Eyelid Blepharoplasty or Lower Eyelid Blepharoplasty. The surgery that best rejuvenates you will depend on your desired effect and your facial anatomy which your surgeon will discuss with you at length.