The ideal brow position is different between males and females. Studies that evaluated what’s considered an “attractive brow” concluded that in females it should be positioned slightly above the bony rim over the eye and it should have a gentle upward curve at the tail of the brow. In other words, the inner portion of the brow towards the nose should be lower in position compared to the tail of the brow towards the outer corner of the eye. On the contrary, a male’s brow travels in a relatively straight line staying at the level of the bony rim.
Brow descent occurs over time in some people with varying degree. Generally, the tail of the brow tends to descend with age. If you are above the age of 40, place your finger on the tail of your brow while looking in the mirror and give it a gentle lift, do you see the difference? This usually results in an immediate opening of the eye space and a pleasing look of the eye. When the brow descends further though, it narrows the space between the brow and the upper eyelid. In severe cases, the heaviness of the droopy brow, also known as brow ptosis, and excess upper eyelid skin exert pressure on the lid and make it difficult for it to open properly. Patients usually compensate by actively raising their eyebrows to improve the eye opening and clear their vision. This is done through the forehead muscle that becomes overactive to continuously elevate the brow. However, as the day passes the muscle gets tired and the brow becomes heavy again. Patients notice that at the end of the day, their upper eyelids feel heavy and they look sleepy or tired. A brow lift and upper blepharoplasty help restore the brow position and get rid of the excess skin in the upper eyelid.
Goal of the procedure
The ultimate goal of a brow lift is to restore an attractive position and shape of the brow in relationship to the eye, with a slight upward curve in females and a straight line in males. It also opens up the eye space, helps eliminate temporal hooding and compliments the results of upper blepharoplasty. Our research on ideal upper eyelid aesthetic proportions (link) that was published in the Aesthetic Surgery Journal clearly showed that the arc or curve of the brow is very important component of an attractive looking eye.
What are the different types of brow lift?
There are several types and they range in their complexity and degree of lift they can accomplish. The type of brow lift is chosen depending on the severity of brow droopiness and the patient’s anatomy including the hair line. The types of procedures range from non-surgical brow elevation as in the injection of botulinum toxin (Botox) to a full surgical brow lift. Botox injection weakens the facial muscles that act to lower the brow (as in frowning) and as a result it can cause a minor elevation (1-2 mm). Surgical lift can be performed to the entire brow or to the tail of the brow. Amman based board-certified plastic surgeon Dr. Alghoul prefers minimally invasive techniques and short hidden scars when performing brow lift procedures and he avoids any over correction that may result in an unnatural look.
Dr. Alghoul follows a balanced approach to rejuvenation of the upper eyelids and brow which he often treats as one unit. He will usually use a combination of removing skin excess, adding volume to the brow, temporal area and upper lid fold in the form of fat grafting or filler injectables and will elevate the tale of the brow as needed. He reserves full brow lift to patients who have significant brow sagging.
Who is a good candidate for a brow lift?
Patients who are unhappy with the shape, position, or symmetry of their eye brows may benefit from a procedure that can lift the brow. Patients with hyperactive corrugator muscles (frown muscle) and mild asymmetry or droopiness of the brow can be treated with Botox injection or removal of the muscles. Patients with droopiness of the tail of the brow with excess skin of the upper lid are good candidates for elevation of the tail of the brow (temporal brow lift) and upper blepharoplasty. The procedure is performed through limited incisions and can utilize endoscopic technique depending on the degree of elevation desired (patient example). Patients with severe droopiness (brow ptosis) are good candidates for a full brow lift which is done through different techniques depending on the facial anatomy and status of the patient’s hairline (e.g. receding hair line, male baldness, etc.)
Generally, in males presenting with changes in the upper lid, a brow lift is needed. Men’s brows are heavier and tend to cause increased load on the upper lid. As a result, many males presenting for upper blepharoplasty need a brow lift at the same time, since removing the upper lid skin alone will result in unsatisfactory results that are not long lasting.
Does brow lift correct forehead wrinkles?
Forehead wrinkles are expression lines that become permanent as we age. The corrugator is a muscle present underneath the brow and is responsible for lowering both brows and bringing them together towards the midline. This creates the frown lines. Patients with hyperactive muscles often have an angry and serious look. Repetitive muscle movement causes the wrinkles to deepen with time and become permanent. One way to prevent this is through periodic weakening of the muscle with botulinum toxin. Removal of the corrugator muscles is often performed with a brow lift procedure to help elevate the brow and eliminate the frown lines.
What is the recovery time?
Minimal bruising is common after surgery and usually resolves within a week. Swelling is also common and extends to both upper lids but resolves gradually over one to two weeks. Skin sutures are removed in the office after seven days. You may engage in light activity on the day after surgery. Return to normal activity, including exercise, may take one to two weeks.
Where is the procedure performed?
Dr. Alghoul performs brow lift surgery in Amman as an outpatient procedure, most commonly under general anesthesia or local anesthesia and sedation, although this depends on the extent of the procedure.
Is brow lift covered by insurance?
Brow lift is typically not covered by insurance unless the brows are very heavy and significantly affecting the visual field. A visual field test and a letter dictated by your doctor are usually required. Our staff will help you through this precertification process.