Browlift
Sarasota Brow Lift
Who is a candidate?
If you look tired or angry when you are not, it may be related to the position of your eyebrows.
Why do I look tired or angry when I am not?
As we age, the brows descend gradually from their youthful position. The sagging brow tissue crowds the eyes often resulting in a tired, weathered look. Some patients complain that they have developed a stern or angry look. The stern or angry look is related to drooping of the tissue between the eyebrows and to the presence of prominent frown lines (vertical glabellar lines).
What is the normal position of the brows?
Normal brow position is different for men and women. For women, the normal youthful brow arches above the bony superior orbital rim (upper part of the eye socket) such that the high point of the brow lines up (vertically) with the outer part of the colored part of the eye (iris). The brow is generally club-shaped at the end nearest the nose and generally tapers toward the other end. The brow is usually less arched and more inferiorly located (positioned at the level of the superior orbital rim) in males.
Medical evaluation for a brow lift:
Important considerations include but are not limited to previous surgery, position of the anterior (frontal) hairline, upper eyelid position, dry eye symptoms and the presence of frown lines.
Previous surgery:
If you have previously undergone browlift surgery and/or upper eyelid lift you may or not be a good candidate for a revision (secondary) browlift. The main consideration relates to your ability to maintain adequate eye closure following the revision browlift surgery.
Hairline position:
The position of your (anterior/frontal) hairline should be a major consideration in your surgeon's planning for browlift surgery. Two of the three most common techniques for browlift surgery in women (coronal and endoscopic browlift) will elevate the anterior (frontal) hairline. Patients with a low hairline (and short forehead) need not worry about expected elevation of the hairline with either the coronal or endoscopic browlift.
The same cannot be said about patients with a relatively high hairline (and a longer forehead). Many patients with a pre-existing elevated or borderline-elevated hairline believe that they are not good candidates for a browlift because their hairline will end-up even higher. Fortunately, an alternative technique (trichophytic browlift aka hairline approach) allows for maintenance or even lowering the position of the frontal hairline. With this approach some of the bare upper forehead skin is removed as the brows are lifted. While the incision is not hidden completely within the hair, visibility of the incision is minimized by meticulous surgical technique that enables hair growth through the thin suture line after surgery.
Upper eyelid position:
The main consideration relates to your ability to maintain adequate eye closure following surgery. Your surgeon should manually elevate your brow and ask you to close your eyes. He/she will then be able to determine whether you will likely have adequate eye closure following browlift surgery. He/she will also be able to determine whether an upper eyelid lift should be done at the time of your browlift surgery.
Dry eye symptoms:
Patients with dry eyes may not be good candidates for browlift surgery. A thorough pre-operative evaluation by an ophthalmologist may be necessary for patients with dry eyes.
Frown lines:
Any of the three browlift procedures commonly used in women will allow for simultaneous treatment of the muscles (corrugator) responsible for frown lines. The treatment involves removing the middle part of the corrugator muscle so that it cannot become active again. Botox injections should not be necessary for treatment of frown lines after surgery. Complete or near-complete elimination of frown lines may require simultaneous treatment of the skin over the corrugator muscles (e.g. laser skin resurfacing).