What Are the Benefits of Brow Suspension?

I have tried many techniques of minimally invasive brow suspension and in my humble opinion they don't work any better (and at time not as good as) Botox injections and they don't last any longer than Botox injections.

I am always struck by patients' preoperative trepidation about undergoing brow lift as the procedure is tremendously successful. Many have the preconceived notion that ptosis or sagging in the upper eyelids requires blepharoplasty whereas the reason for the ptosis is sag in the brows. Except in instances of baldness, the scars are hidden inside the hairline and recuperation is quite rapid. I have yet to be convinced of the efficacy of the endoscopic procedure or by modified surgery in this area.

The fact that there are SO many ways to raise the brows indicates that none of them is the unquestioned "best" way to do so. While the old Coronal Brow Lift has been the unquestioned gold standard for lifting the brow, we have seen Endoscopic Brow Lift coming to the scene and then slowly leaving. We have seen limited "open" brow lift methods being suggested and a flurry of barbed suture Brow Lift techniques come and go.

The limiting facts in Brow Lifting are
- The brows need to be lifted centrally to maintain their graceful arch. Lifting the brows more laterally results in a demonic, Mr. Spock surprised look which is less than attractive
- After the brows are lifted the great challenge is to keep them in that position while the tissues are healing. If the brows drop soon after surgery not much is achieved.

Suture suspension, in my opinion, is hampered by multiple factors: the visibility of the sutures in thin skinned people (creating a "Banjo stringing" effect), the fact that no real scar tissue is created under the brows in their new position to weld them in place means that when the sutures break or have to be replaced, the brows will sag.

In all, a "not ready for prime time" procedure.

Peter A Aldea, MD