The brow and the eye have a close relationship. As the eyebrow descends it can create fullness along the eye. As the brow is lifted, so too can the fullness along the outside of the upper eye. While this is an overly simplified explanation of the relationship between brow and eye, it does serve to point that analysis of one can not be complete without analysis of the other.
Botox and Facial Fillers
Botox and facial fillers can help temporarily raise the brow complex. In some patients the cause of a descended brow is not necessarily descension but loss of volume. Volume can lift a brow and help improve the contour of the eye brow interface.
Endoscopic Brow Lift
The endoscopic brow lift is the currently the most commonly performed procedure for rejuvenation of the brow. The ideal candidate is a female patient with a normal or low hairline, thin skin, and a flat forehead. The endoscopic brow lift can be performed in either a subgaleal or subperiosteal plane. Releasing the periosteum of the arcus marginalis and the orbital ligament adequately mobilizes the brow and helps achieve a long term result. The method of fixation of the brow varies with polylactic resorbable screws or bone tunnels. Some surgeons have achieved long-term brow elevation without the need for fixation. The endoscopic forehead lift has the advantage of minimal incision length and less risk of paraesthesias.
Coronal Brow Lift/ Tricophytic Brow Lift/ Pretrichial Brow Lift
In a coronal brow lift, the surgeon makes an incision within the hair-bearing scalp. The procedure will lead to elevation of the hairline. The plane of dissection is in the subgaleal plane allowing access to the frontalis, corrugator, and procerus muscles. Coronal brow lifting is contraindicated in patients with high hairlines or male pattern baldness. In addition, paraesthesias is common after this technique due to resection of the deep branch of the supraorbital nerve.
The tricophytic brow lift makes an incision within the fine hair of the anterior hairline. A reverse bevel allows for hair growth through the incision. A pretrichial variant places the scar in front of the hairline. Both approaches are effective in patients with high hairlines.
Midforehead Brow Lift/Direct Browlift
A midforehead brow lift is made with an incision in a horizontal furrow in the forehead. A direct brow lift is made by directly excising skin above a patient’s brow. Typical candidates for both procedures include bald male patients with prominent forehead wrinkles and patients with a highly asymmetric brow (facial paralysis patients). Forehead wrinkles and corrugator hyperactivity are not addressed with this technique.