Along with other areas of the face, the eyebrows and forehead also fall prey to the effects of time and gravity. A number of procedures are available to address this aging process, but I believe that the best way to approach the problem is also the simplest, which is the individual eyebrow lift. Only with this method can you both lift and shape the eyebrows. Unusual circumstances may occasionally require other methods.
The most common method of addressing the changes that affect the forehead is a technique known as the “coronal forehead lift”. This involves the creation of an incision extending from one ear to the other over the top of the head. The scalp is the reflected down to the level of the eyebrows. While this sounds complex, it is actually quite simple assuming that you know what you are doing. A portion of the scalp is then removed, which results in a “lift” of the eyebrows.
I have never been a big fan of the coronal forehead lift. My main objection is since the scalp and forehead skin is comparatively quite rigid, much like a piece of leather, the eyebrows are merely moved upwards as a unit and little shaping results. Also, the hairline winds up lifted too much, which results in a towering forehead; not a particularly attractive feature, especially in a woman. Other problems include hair loss or hair thinning, which most women do not appreciate. Needless to say men with “male pattern baldness”, and most men after a certain age, are not good candidates for the coronal forehead lift.
To address these short-comings, a procedure known as an “endoforehead lift” has gained popularity. This involves the use of an endoscope, which is essentially a tiny tube with a camera at one end, which allows you to operate with small and minimal scars. This is the same technology that you hear about that allows surgery of the gall bladder, knees, shoulders, and other areas with minimal incisions. While I have performed many of these procedures, my original objection persists; which is that little shaping of the individual eyebrows can result.
For these reasons I usually recommend the simplest and cleanest approach, known as the “individual eyebrow lift”. This involves an incision above each eyebrow at the level of the hairline, most of which is hidden behind the hairline, and which allows the eyebrows to be lifted and shaped individually. The dissection is subcutaneous or just under the skin and extends down to the level of the eyebrows which are structures that are part of the skin. This allows great license to lift and shape the eyebrow to best improve the appearance of the individual. It also does not raise the hairline and has less problems with circulation and healing. Women, in particular, have eyebrows which are arched and have a peak in the outer third of the brow. This technique is perfect to reproduce this natural appearance. On rare occassions, one of the other techniques is indicated.