Elevation of the brow can be performed surgically using several techniques. A few of the variables that need to be considered in choosing the particular surgical approach for brow elevation are the sex of the patient due to the potential for male pattern baldness, the height of the hairline, and whether or not all parts of the brow need elevation. I prefer to use the endoscopic approach to brow lifting particularly in females with a low or normal hairline. The endoscopic approach is performed by placing 3 to 5 small incisions into the hair bearing scalp and elevating the forehead scalp including the brow beneath the skin so that there are no visible surgical incisions. Endoscopes help the surgeon identify the important muscles, nerves, and vessels which need to be protected or dissected in order to complete the browlift.
In women with a higher hairline, I would suggest using a larger incision in the front of the scalp called a pretrichal incision. The pretrichal incision follows the frontal hairline and the incision is camouflaged in the small hairs of the front of the hairline. Once the incision is made, the brow is elevated by elevating all of the skin and muscle of the forehead, along with the eyebrow. The incision allows non hair bearing skin of the forehead to be removed when elevating the eyebrow without elevating what is usually an already elevated hairline.
In men, the approach to brow lifting needs to be tailored with the knowledge that the incisions that are used in women will likely become visible in men once the males hair begins to thin. In men, I use either an approach where the incision is placed only in the temple where the hair is last to go, or an incision that is hidden in the upper eyelid called a transblepharoplasty browlift.
Once the surgical approach has been decided upon, it is important that the brow is appropriately designed so that it looks aesthetically pleasing on the patient. Female patients tend to have an eyebrow that is thicker in the portion closest to the nose and tapers at the portion closest to the ear. The height of the female eyebrow is at the level of the orbital bony rim at the portion closest to the nose, then subtlety elevates to a gentle peak above the orbital bone to the outside of a line that would be equal to the position of the pupil when looking straight on. Male eyebrows tend to also be thicker towards the nose and thinner towards the ear; however, the height of the male eyebrow is less exaggerated than in females and looks best either at or just above the orbital bone.
There is no specific preparation which you will need to undertake prior to your browlift surgery. If you are a smoker, now is the time to quit. Avoid non-steroidal anti-inflammatory medications like Motrin and Advil as well as aspirin to avoid bruising and excessive bleeding. Finally, if you are taking vitamins and supplements it is probably a good idea to stop them two weeks ahead of time as many supplements have been linked to bleeding post operatively.
