Cosmetic Surgery:
Raising a Few Eyebrows

By Dr. Paul G. Pin
Dallas Board-Certified Plastic Surgeon

"When Should I start thinking about cosmetic surgery?" -- This is a very common question posed by middle-age women and men who are just noticing the first signs of facial aging. I try to focus on "why" rather than "when". Some lucky people just seem genetically shielded from aging and look great well into their 60s. The rest of us (an envious lot) notice aging around 40 when our brows begin to settle. Frequently, this condition goes unrecognized but is brought to our attention by a well meaning friend or family member: "Are you mad?" "Are you tired?" "You look unhappy." Others describe their low brow appearance.

The Idea -- Brow position refers not only to our eyebrows but also the excess tissue in our upper eyelids, particularly in the outer aspect where "crows fee" develop. Droopy or ptotic brows frequently cause patients to seek help because the excess skin obscures their upper lids, making it hard to wear eye shadow. Some patients feel their eyes look smaller. Interestingly, few patients realize it is their brows that need treatment rather than just their eyelids.

When discussing eyelid or orbital rejuvenation with a patient, it is easy to demonstrate how they will look with their brows elevated. The patient can expect to look refreshed, happier, more open-eyed, without looking surprised or startled. Additionally, browlifts dramatically reduce forehead wrinkles and frown lines.

The Procedure -- For practical purposes, there are three different approaches to brow elevation: endoscopic, hairline and coronal (top of head).

An endoscopic browlift uses two or three one inch incisions just behind the hairline. A camera called an endoscope is then inserted and use to free the brows so they can be elevated. This procedure has been commonly performed for about five years and uses modern technology to allow brow elevation through limited incisions. Unfortunately, results are unpredictable; while some patients achieve their goals, others experience minimal long-term improvement. Endoscopic browlifts are most useful among patients who are averse to long incisions or desire only subtle brow elevation.

Hairline and coronal brow lifts are more traditional techniques and involve long incisions, either at the hairline or about 4 inches behind it, as in a coronal browlift. Coronal browlifts will move the hairline back and therefore useful in patients with thick and a low normal hairline. Hairline browlifts actually reduce the height of the forehead and are popular in patients with long foreheads (or high hairlines). Though each technique results in scalp numbness, they tend to elevate the brow much more effectively and reliably than an endoscopic lift.

However, there is no right way to perform a browlift. As with any cosmetic surgical procedure the advantages and disadvantages of a given technique have to be considered in light of a patient's goals and preferences.

The Practical Part -- The setting and recovery for a browlift depend on whether it is done along or in conjunction with other procedures, such as a facelift. When done as the only procedure, or with a blepharoplasty, a browlift is more commonly done under general anesthesia as an outpatient procedure. Browlifts result in significant swelling and bruising for a few days, and most patients report moderate discomfort. Fortunately, recovery is rapid and most patients can return to week within a week or so.

Overall browlifts are a clever way to restore a rested, more youthful appearance to the upper face. Patients frequently find a browlift makes them look as good as they feel.

Paul G. Pin, M.D.
Board Certified,
American Board of Plastic Surgery
Dallas, Texas
www.paulpin.com

Browlift surgery is real surgery and involves risks such as bleeding, infection, and scarring. Results vary. Dr. Pin will be happy to discuss these and other risks of surgery for brow lifts.