The patient is a 66 year old woman who noted that her family told he she looked angry all the time. She felt it was because her brows were low and sought consultation to have a brow lift. Browlifts are really facelifts of the upper portion of the face. Goals include not only raising the brow level but changing the shape of the brow. With the aging process, the brows fall and become flat and lose their shape. Brows need to curve around the eye in a natural fashion complementing the region about the eyes. The highest point of the eyebrow should coincide with the outside most edge of the iris, which is the colored part of the eye itself. The curve of the brow should be gentle with no sharp bends, which can make the patient appear fiendish. With the brow at a good level and with a great shape, patients look more calm and confident and less angry and sullen or pensive.
Brow lifts smooth out the skin around the eyes and can smooth folds as with this patient where the surgery smoothed out the fold of skin between the eyes. Damaged and wrinkled skin closer to the eyelids are also smoothed out as can be seen her with elimination of the Crow’s foot wrinkles and smoothing of excess skin outside the eyes and smoothing and removal of excess hooding within the upper eyelid. There is also a larger space created between the brow and the eyelid and this not only creates smooth lines but also restores a youthful appearance to the face.
Browlifts also help to smooth wrinkles because this procedure also focuses on the muscles of the forehead and region around the eyes. All muscles are preserved in a brow lift but the corrugator which is removed. The corrugator muscle, when flexed, furrows the skin between the brow, creating folds and wrinkles. These are the folds and wrinkles that bother some patients and for whom Botox is a good solution. Botox paralyzes the corrugator muscle and so patients that have Botox are not able to flex the corrugator muscle and don’t have any folding or lines between their brows. Since Botox only lasts, at most three and a half months, keeping the muscle inactive requires frequent trips for Botox injections. During a browlift, anywhere from 75 to 100% of the muscle is completely removed and so Botox is no longer necessary to achieve that smooth, wrinkle free look.
Botox is also used to decrease wrinkles of the forehead, as it has in this patient but with only Botox and not a brow lift the brow can fall which is an undesirable result of Botox treatment. Browlifting both raises the brow and eliminates horizontal wrikles of the forehead because it raises the brows permanently so the patient doesn’t have to raise their low brows which creates the horizontal wrinkles in the first place.
Brow lifts smooth out the Crow’s feet areas. Some patients have not only wrinkles in this area but also some folding and this folding and muscle activity at the outside of the eyelid area can detract from beauty and take other’s gaze away from our eyes when they are looking directly at us. The laser can also be used, in addition to a Brow lift to remove all of the wrinkles in the Crow’s foot areas. Healing from the laser treatments is quick and the skin is ready for make up application by the time the brow lift is healied, which is approximately at one week or sooner. The laser treatment for wrinkles creates moist skin and patients do skin care cleanings after the laser treatment. This cleaning is an extension of make-up application so patients who like applying make up will enjoy the cleaning. Once the skin is healed, which is about four days, there is new pink baby skin and then make up can be applied. Make up is generally required thereafter to cover the pink skin and can be discontinued when the skin returns to normal color. Special make up can be purchased to provide this cover and stick better to the skin than normal make up especially in the warm months when there is more sweating and patients are more active. Up until approximately two and a half weeks after laser treatment, the skin appear slightly darker and shiny under make up. After this time, when patients are wearing make up the skin is becoming lighter and the normal skin roughness returns and at this point, when patients are wearing make-up its hard to tell that the laser has been performed. Some patients with some pigment in their skin go through a hyperpigmentation phase at this point because the laser has stimulated the pigment producing cells of the skin. The increased pigment seen in these patients can easily be covered with make up as camoflage. Make up not only covers the skin color changes caused by the laser but also protects the new smooth skin from the harsh effets of sunlight. Sunlight contains ultraviolet rays that not only injure our skin but for patients that have had the laser to remove wrinkles, cause the pink phase to be prolonged.
When brow lifting raises the brow, it creates more space between the brow and the eyelid which give a soft look to the face and restores harmony especially when the area between the brow and eyelid is compressed from drooping of the brow. With expansion of this space to create beauty, hooding can be minimized oar eliminated by the brow lift which also creates beauty. Hooding, or the folding of skin that appears with the aging process, can make patients look older than they really are. Most patients simply require skin removal in this area. But for those who have hooding because the brow is low, a brow lift might be necessary to get significant improvement. So hooding can represent skin folding and laxity itself or the brow can be pushing the skin down and creating skin hooding of the upper lid. Most patients have both as the cause of their hooding and, at consultation with a plastic surgeon, the cause of the hooding can be evaluated and a plan crafted to improve on the hooding with a consideration of other goals and alternatives.
