In my hands, brow lifts are treated as brow relaxation procedures. Slight elevation of the brows can create a perception of relaxation and can minimize the need for upper eyelid surgery.
I explain to female patients that one of the goals is to elevate the brow, with emphasis on the lateral third or "tail" of the brow. Furthermore, the major goal of the procedure is not to achieve an Olympic record in brow height, but to create the perception of a more relaxed person. The second goal of a brow procedure is to minimize the central forehead lines through surgical division of the muscles that work in the glabella (corrugator supercilli and procerus).
I utilize two primary techniques in performing brow procedures:
The Endoscopic approach and the Trichophytic Approach. I make the decision on which technique to use (with the patient) based on the height of the patient's hairline. The advantages of the Endoscopic approach are: 1) smaller incisions within the hairline (typically four 1.5 cm incisions), 2) less recovery time. Typically an absorbable fixation device such as an Endotyne (absorbable implant) is used to hold the brow in position during the recovery period. The disadvantages include: 1) potential hairline elevation, 2) potential for less longevity of cosmetic benefit.
The advantages of the Trichophytic Approach (the incision is placed along the frontal hairline in an irregular wavy pattern, mimicking the normal advancement and recession of hair growth) are 1) a high hairline can be lowered or stabilized, 2) greater control over brow elevation, 3) hair will grow through the hairline scar, thereby concealing it. The disadvantages include: 1) a longer scar, 2) longer recovery time. Consultation with your surgeon will help determine which technique works best for you.
Brow relaxation procedures should generally be subtle; there are few tell tale signs of cosmetic surgery that are more obvious than an over elevated brow, or a patient with a high central brow position (quizzical look). In my opinion, a brow lift must be done very carefully in a male patient. Over elevation of the male brow lends itself to a more feminine appearance.
