Do you recommend thread lifts to lift brows for patient with large forehead and heavy low brows?

Question

I already had consultations with board certified plastic surgeons. Some say to avoid endoscopic brow lift because it will make my forehead larger. The trichophytic brow lift will leave a huge scar accross my face. Botox brow lift will only lift my brows about 2-3 mm. Some surgeons told me that thread lifts are ok and others said they will cause internal scarring and I will regret it in the future. Another surgeon told me internal scarring is good because it will keep my forehead and brows high

Dean P. Kane, MD, FACS · Answer

Dear Mariakimlopez, 
You have received good information on your journey toward brow lift. Each option has advantages and disadvantages to be reviewed by you and the surgeon. Choose the best qualified Board Certified Plastic Surgeon to perform that particular style of procedure. Since I have no ability to examine you, the following are generalities and caveats to consider. 
1.	Yes, a endoscopic and coronal forehead lift will stretch the forehead and make it longer. The endoscopic lift generally is performed under the periosteum and so the skin and fatty gliding layer will sag more quickly as no scar production (ie collagen) will hold it in place. This is similar to the “loss of lift” that occurs with “botox”. A coronal forehead lift will remove hair bearing scalp tissue and a pretrichophtic brow lift will remove excess forehead skin leaving scars and some areas of sensation changes but provide the most durable, long lasting lift. 
2.	A thread brow lift will last longer than botox and much shorter than a skin removing forehead / brow lift but the risk of complications are far less and can be performed multiple times under local anesthetic in a treatment room.
3.	Having explained that it is the redraping of the skin with its collagen / scar attachment to the underlying muscle that is the desired goal of a more durable browlift, I also offer a Brow ThreadLift with undermining of the subcutaneous plane to provide for a new adhesion of the forehead skin further up the lifting frontalis muscle and keep it in place with brow shaping via the use of threadlift / suspension sutures. 
4.	An option I have performed for highly selected patients with very heavy foreheads and multiple forehead horizontal furrows is a “gullwing” style mid-forehead skin excision (as might be performed for removal of a skin cancer) removing 2 or more creases. It creates a wrinkle-like line similar to a crease. Such selected individuals will wear a hat covering the incision until it has faded. 
You are taking proper steps in the decision making process. I wish you all the best.

Do you recommend thread lifts to lift brows for patient with large forehead and heavy low brows?

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