The forehead and brow represent the upper third of the face. Much like the jowling that occurs in the lower face, the upper face can appear older due to a lower brow position. There are both non-surgical and surgical options to address the aging upper face.
A modern, beautiful forehead and brow is one where the outer (lateral) brow sits slightly higher than the lower inner (medial) brow. Often times, the inner brow sits rather low. A raised, Kenny Rogers, look is a surprised look and is not natural. The focus should be on pulling the outer brow up. This helps rejuvenate the brow, but also reduces lateral brow hooding. There are several options available that include both surgical and non-surgical treatments, depending on the age and severity of the brow drop and wrinkles.
Botulinim toxin (Botox, Xeomin, Dysport) injections are a quick and easy way to rejuvenation the forehead. Approximately 50 units are used to treat the “11” lines between the eyebrows, forehead lines, crows feet, and upper forehead lines. A small amount (3-5 units) can be injected into each lower lateral brow to block the inferior pull of the orbicularis to help lift the lateral brow. Dr. Richards will be able to determine if this is the right treatment option for you.
Historically, plastic surgeons would make a long incision across the top of the head from ear to ear. This was called a “coronal” brow lift. The entire forehead complex would be elevated off of the skull from the top of the head all the way just above the top of the eyes. This was traditionally done, but resulted in a very long and painful recovery period, risk to permanent injury to nerves as well as prolonged swelling. Dr. Richards, received formal fellowship training in cosmetic plastic surgery at the Cleveland Clinic and offers techniques that are less painful and require shorter recovery times than these older treatment modalities.
Modern Lateral Superficial Brow Lift – Dr. Richards prefers a modern superficial brow lift for patients with significant brow hooding and brow drop. The incision is inconspicuously places along the hairline, and requires approximately only 7-8 cm incision on each side. The skin is elevated in a very superficial plane to allow the redundant skin to be removed. This will help lift the lateral brow and position the brow in a much more youthful position. This operation will remove redundant skin, unlike endoscopic approaches that do not remove the excess skin. The wound is then closed with absorbable sutures that don’t require removal postoperatively. The closure of the incision is done in a way that allows hair to grow through the scar in order to hide the incision. Recovery is approximately 2 weeks before swelling and bruising completely resolve.
Endoscopic Brow Lift – If the scar along the hair line is of major concern, another option is the endoscopic approach. Dr. Richards offers the endoscopic forehead lift only at his Las Vegas location. This procedure does not remove skin and may not be the best option for patients with significant out brown hooding. The endoscopic approach requires 3-4 small incisions (approximately 2cm each) that are hidden in the hair line. The elevation of the forehead complex is visualized through a small camera placed in the central incision in the hairline. Endoscopic elevator instruments help to release deep attachments to the brow, to allow for a subtle, natural rejuvenation. This procedure is very popular for patients who don’t want a hairline scar. Again, recovery is 2 weeks. This procedure has a more painful recovery than the modern lateral superifical brow lift because the nerves are dissected from underneath the forehead complex.
Dr. Richards will be happy to consult with you personally to address your questions and concerns regarding brow rejuvenation. He will go over in detail the risks, recovery expectations, and likely achievable results with you.