How does ageing affect the brow?
The brow is one of the first structures on the face to show visible changes of ageing. The effect of gravity, muscle pull and loss of skin elasticity affects the brows as early as the early 40’s. The outer part of the brow (lateral brow) is the part that gets affected the most and slowly starts drooping /descending down- called brow ptosis. The outer third of the eye brow is relatively unsupported and rests on a smooth surface which allows early descend of the brow downwards. The muscles that cause blinking of the eyelid (orbicularis oculi) and frowning (corrugator muscle) also pull the outer brow down. In severe ageing changes the inner part of the eyebrow also droops down.
What are the aesthetic impacts of brow descent?
A drooping brow creates a tired look to the face. It causes heaviness of the upper lids which makes us subconsciously raise the eyebrows. Raising the eyebrows constantly results in deep forehead lines. In early stages, this subconscious raising of eyebrows adequately compensates the brow descent. As the brows droops further with ageing, there is a permanent tired look. The lowering of brows causes the upper lid skin to get folded and look like curtains of skin on the upper lid. The normal aesthetic arch of the eyebrows changes to a flat line or even a reverse arching. The aesthetic impact of the brow ptosis- tired, unrested look, deep lines on forehead, excess skin on upper eyelid causing loss of the normal shelf on the lid Severe brow ptosis can also cause obstruction of vision
Methods for brow lift:
Techniques for brow lift have evolved over the decades. Traditional methods are still relevant, but minimally invasive procedures are definitely effective and more popular. The ‘open’ brow lift involves a long incision across the scalp and elevation of the entire forehead skin, which is then pulled back. The result of this procedure has been consistently good over the years. The long scar and its attendant problems of hair loss and altered sensations created a need for less invasive methods for brow lift/ forehead rejuvenation. Endoscopic brow lift and non endoscopic limited incision brow lift are two excellent options which deliver aesthetically pleasing results through tiny cuts and minimal down time. These techniques have been developed using sound anatomical basis and keeping in mind the requirements of a patient seeking cosmetic surgical enhancement. Endotines are implantable devices occasionally used in brow lift to suspend the brow or to hold the elevated skin in the desired position. Endotines are used in certain techniques like endoscopic brow lift and Trans blepharoplasty brow lift.
The different methods available for brow lift now are-
Traditional open brow lift
Limited incision non endoscopic brow lift
Endoscopic brow lift
Trans blepharoplasty brow lift
Sub cutaneous brow lift.
Botox brow lift (non surgical)
The selection of the appropriate procedure in each case will depend on the severity of brow ptosis and other factors, which will be carefully evaluated before making the decision.
Timing of brow lift-
For any rejuvenation procedure it is “earlier the better” and it holds true for brow lift also. In early stages, non surgical methods are highly effective. Most brow lifts are performed in the age between 40-80 years. Since brow descend happens early in the ageing process, most brow lifts are performed in the 40’s and 50’s.
How is the surgery done?
There is remarkable variation in the surgical steps in each procedure. The basic steps involved include-
Surgical elevation of the forehead skin from the frontal bone
Removal/ modification of excess skin
Transaction/excision of the depressor muscle of brow
Suspension of the brow in the desirable position.
How long does the effect last?
Brow lifting/ forehead lift reverses the ageing changes which have happened over the last few decades of life. The effects are powerful and last for many years. Since ageing and effects of gravity are ongoing, permanent reversal is not possible.
Other procedures along with brow lift:
Ageing affects the entire face and so most brow lifts are performed in combination with other facial rejuvenation procedures like eyelid surgery (blepharoplasty), face lift, neck lift or fat grafting. Brow lift can also be combined with other cosmetic surgery procedures like breast augmentation, breast lift, and tummy tuck provided you are medically fit to undergo combination surgeries.
Brow lifting has a good safety record and very high patient delight rates. The specific risks will depend on the technique used. Over correction or under correction are rare correctable problems. Temporary change in sensation over forehead, hair loss near scalp incisions and bleeding under the skin flap are possible, but rarely encountered risks.
Botox brow lift:
Botulinum toxin in minute doses is selectively injected into facial muscles to create non surgical rejuvenation. Since brow descend is in part brought about by muscle pull, weakening/blocking those muscles will result in elevation of the outer brow. This procedure is called Botox brow lift and is immensely popular for correcting early brow ptosis. This is an office procedure and takes 20 minutes to execute. The results are visible in 5-7 days and last for about 6 months.