Brow Lift Failure - Options to Fix?

With due respect without photographs and an inconsistent history it is very hard to advise you.

A CORONAL Browlift involves an incision over the crown of the head, pulling up of the forehead back / lifting the brows and smoothing the forehead. The excess forhead back of the incision is trimmed and the scar is hidden in the scalp. Such an operation has no brow fixation "anchor points" to come undone. The only way the brows could sag here is with separation of the wound. (You would have known if this rare complication happened).  There are SEVERAL other ways to lift the brows - some OPEN, others with a scope (endoscopic). But EACH one of them is far from perfect and has its advantages and drawbacks.

As 3 ethical colleagues have already told you, you cannot lift a brow by taking away upper lid skin beneath it. To lift a brow - you must pull / move it upwards. To do it better NEXT time, we need to know how the first one was done and WHY did it fail (Poor fixation?, Poor technique? Poor Tissues? All or none of the above?).

As to your last question. You WILL need surgery to lift the brows. A fallen brow will NOT go up significantly (although you CAN get a mild improvement with a skillful application of Botox). Laser resurfacing is utterly useless here. Thread lifts may work temporarily but are associated with banjo stringing / palpable and visible strings as well as slippage, asymmetry and infection. The CHOICE of which TYPE of a Brow lift is between you and your surgeon. It would depend on your anatomy and his experience.

Good Luck.

Peter A Aldea, MD

I think I share the confusion of a lot of the authors here in that coronal brow lifts actually involve the excision or removal of a portion of scalp, allowing direct pull on the entire skin/muscle flap of your forehead. "Fixation" points per se are more apt descriptors for an endoscopic, minimally-invasive lift, where the pull is maintained by fixating the tissue to the bone. In a coronal lift, the lift effect is achieved by virtue of the fact that the hairline is raised, pulling on everything that is in front of the incision as the gap is bridged by closing the incision.

A so-called "hairline lowering" forehead lift is another approach that puts the incision at the edge of the hairline, rather than at the top of the head, and can achieve a powerful lift on the brows without moving the hairline upward. That might be a good approach for you, but I am concerned that the skin between the new hairline incision and the prior coronal scar, if indeed you had a coronal lift, would be at some risk for blood supply problems. The scalp is pretty rich in blood supply, though, so I doubt it would be a major issue.

Probably best to talk to your plastic surgeon and see what your options are. You always have the option of getting a second opinion as well. Lifts might seem like simple procedures but they are not - gravity is a strong force, and revisions are not uncommon.

 

If the endo brow failed then I would go to a coronal brow lift.  There are several variations of this procedure so you may want to see your initial surgeon as well as several others.  Don't rush into anything without having all the info you need to make an intelligent decision.