Endoscopic Brow Lift
Brow Aesthetics Female vs Male
Female eyebrows are 2-3 mm above the supraorbital rim (upper bony prominence of the eyeball socket) and have an arch shape. The apex of the arch is at the junction of the inner 2/3rd and outer 2/3rd’s of the eyebrow. This is the highest point of the eyebrow. The inner or medial part of the eyebrow located at the inner corner of the eye is the low point. The eyebrow, then gently arches up towards the apex where the most outer part of the eyebrow is 2-3 mm higher than the inner part.
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Male Eyebrows on the other hand, are located right on the supraorbital rim. They are less arched and straight. The outer part of the eyebrow is close to the same level as the inner part of the eyebrow. The arching that you see is mild to none.
Anatomy of the Brow
The brow is the front area of the scalp with the following layers;
- Subcutaneous Tissue or Fat
- Galea or Frontalis muscle
- Loose areolar tissue layer
- Pericranium or Periosteum
From the superior orbital rim to the hairline the brow length is 5 – 6 cm. Anything more than this can be considered a high forehead anything less and short forehead.
The important nerves and vessels that pass through the brow are the supraorbital and supratrochlear nerves, the frontal or temporal branch of the facial nerve, sentinel vein and supratemporal artery and vein.
The Frontalis muscle is responsible for brow elevation and creates “worry lines”, the horizontal creases, one sees when they elevate the brow. Botox is commonly used to temporarily treat these lines. Depressors of the brow include the Procerus muscle, corrugator muscles and the orbicularis oculi muscle. These muscles create the 11’s lines when contracted.
The depressor muscles are important in brow lift because they act as the “brakes” or opposing force for trying to raise the brow up. These muscles can be removed during surgery either partially or almost completely to resist these opposing forces.
Ligaments or Fusion Points
These are strong adherence areas of the brow to the underlying facial skeleton. They fix the brow in position and must be released during surgery to allow mobilization of the brow so that it can be moved upwards.
- Arcus Marginalis at the Superior Orbital Rim
- Superior Temporal Fusion Line
- Lateral Orbital Retaining Ligament
Brow Droop or Ptosis
The brow drops with weakening of the ligaments and soft tissues. Some patients have a low eyebrows genetically. Drooping of the brow will affect the overall appearance of the upper face and eyes. The severity of bow descent and baseline anatomy will determine what procedure will be most effective.
Types of Procedure Performed
- Open Brow Lift: The incision is in three main areas;
- Coronal: 5-6 cm behind the hairline from one side to the other
- Pretrichial or Hairline: Along the hairline
- Direct Brow: Upper part of the eyebrow
- Endoscopic Brow Lift (Minimally Invasive): Small incisions behind the hairline which are well hidden in the hair bearing area.
- Minibrow Lift: Various incisions in front of the hairline or behind the hairline that are smaller. This may be limited to the temporal brow for lateral or outer eyebrow lift.
This is minimally invasive with small incisions behind the hairline. In general no skin is removed and the lift is created by the suspension of the underlying tissues. It is important to go to a Plastic Surgeon who is familiar with this technique. The down time is less than the open technique and healing is quicker.
Longer foreheads are generally not ideal candidates for a coronal incision. This technique will result in the hairline moving back and making the forehead appear longer. Short foreheads are ideal because this technique will elongate the forehead and provide a better balance to the facial aesthetics. Hairline incisions are good for longer foreheads that will not push back the hairline. The direct brow lift is less invasive, however there is a scar above the eyebrow that can possibly be seen. It is important to set the goals and expectations in a thorough consultation with Dr. Parikh prior to your procedure. We can offer brow lift either awake or asleep.