This month’s primer on facial rejuvenation will focus on the upper third of the face – the forehead and brow. These techniques offer a large “bang for the physiological buck.” 

The risk/benefit ratio is quite low, with a great impact on a refreshened “look” for the recovery time and money invested. 

But first, consideration must be given to both anatomy and aesthetics. For example, the usual brow position for women is above the bony ridge above the eyelid. Anatomical position and shape should be tailored with the goal of a natural lift or “look” where the brow is slightly higher with a subtle lateral peak. In men, the youthful brow is a lower, more flattened shape. 

Guidance from a plastic surgeon is important in addressing various desired brow positions. 

Any surgical consult addressing upper eyelid surgery should also address the brow position. Commonly, patients seek improvement of a chronically tired appearance, including hooding around the eyes with a look of fatigue and anger. Brow descent can be severe enough to obstruct a person’s vision. 

On occasion, a patient consults for eyelid surgery yet really needs a browlift – or both, but simply are not offered it or do not know of the technique’s availability. 

For the past decade or so the population has settled into the use of neurotoxins such as Botox, Dysport and Xeomin to create a temporary “chemical browlift.” However, browlift surgery offers a considerably more long-lasting return to a refreshed look without the temporary “frozen” or “over-lifted” look as with neurotoxins. 

There are several variations of browlift techniques, and these can be performed simultaneously with eyelid surgery when needed. Browlift can be performed endoscopically with small incisions hidden at or behind the hairline. Short-scar lateral browlift alone can elevate treated hooding around the eyes. 

A more traditional, full browlift can be performed with a hidden incision just behind the hairline as well. The technique is typically patient and surgeon specific. 

A recent study in JAMA Plastic Surgery stated patients undergoing browlift had a 93% satisfaction rate, with 96% recommending the procedure to others. Further, browlifts are particularly safe with thousands being performed every year under local anesthesia with conscious sedation in an outpatient setting. 

Like upper eyelid surgery, browlifts in general do not require much downtime. Mild swelling and bruising may occur but do not typically interrupt a speedy recovery and return to work. 

If you have been thinking about brightening your appearance, seek an evaluation with a plastic surgeon to see if aesthetic surgery of the forehead and brow might be right for you. 

Mathew T. Epps, MD, MS, DABS is a plastic surgeon, triple- fellowship trained in facial, eyelid, and breast surgery. or