As we age, gravity has an effect on both the upper and lower parts of our face. Heredity, sun damage, and smoking history all contribute to the sagging of the skin and soft tissues. When our forehead sags it creates wrinkles in the forehead and between the brows, brings the eyebrows down which can give us a mean or stern countenance, or even block our vision. Various types of brow lifts can be done to help correct those problems.
There are several different kinds of brow lifts, mostly dependent on where the scar is placed. The simplest is placing an incision just above both brows, taking skin out above the brow so it is elevated. This can leave an unnatural appearing scar. For men who have a receding hairline, the incision is placed across the mid forehead, where there usually are wrinkles. If a patient has a high forehead but fairly normal hairline, the scar can be hidden right along the front of the hair. When patients have a short or normal hairline, the scar can be placed within the hair to completely hide the scars. Dr. Wray will usually do an endoscopic brow lift if this is the case, keeping the scars to a minimum.
Brow lifts will sometimes be considered medically necessary and be covered by insurance if the brows have dropped significantly to actually block vision. This will be determined by visual field testing as well as physical exam.
An endoscopic brow lift is one that is done through incisions that are in the hair, going from front to back. A scope is used to visualize nerves and blood vessels, as well as aid in the dissection of the soft tissue, allowing it to be freed up and pulled back. The biggest advantage of an endoscopic brow lift is that because of the orientation of the scars, they are much less likely to stretch.
Most hairline or endoscopic brow lifts are performed as outpatient procedures. The hair is not shaved, but the head is wrapped in a large dressing which is left on overnight. The next day the patient can usually gently wash his or her hair. Bruising may settle around the eyes, and may take a few weeks to subside. Camouflage makeup will be helpful to hide bruising.