Descent of the eyebrows can crowd the upper eyelid space and appear as though an upper eyelid procedure (blepharoplasty) is necessary. Actually, in many instances, both raising the eyebrows (browlift) and a blepharoplasty are performed at the same time.
There are several approaches to raising the eyebrows. There is the Direct Browlift which excises skin immediately above the eyebrows. It is a fairly simple and quick procedure and should be performed in a patient whose skin does not form obvious scars. Because it is a sharp, crisp line above the eyebrow, it can be somewhat feminizing. Consequently, it is usually performed on a woman who wants a simple procedure or a man with bushy eyebrows that can obscure the scar.
There is the Mid-Forehead Browlift which excises skin through a wrinkle in the middle of the forehead. This is almost never performed on a woman and is usually reserved for balding men who have deep forehead wrinkles. In the right candidate, the procedure is very effective. However, the scars can be red for six months or longer before they gradually fade away.
The Pre-Trichial Browlift excises skin immediately in front of the hairline. It is usually reserved for patients who have a high hairline and do not want it raised any higher. This approach can also be employed to pull the hairline forward and actually lower it.
The Coronal Browlift excises hair bearing skin across the top of the head. Because it creates a very long scar and cuts sensory nerves, which results in 6-12 months of numbness, it has given way to the endoscopic browlift. However, there are special instances when it is useful, such as exposure to drill down prominent brow bones above the eyebrows or to attempt at equalizing asymmetric eyebrows.
The Endoscopic Browlift, which uses special elevators and rigid telescopes through small scalp incisions, raises and fixes the entire forehead and eyebrows after freeing them from their underlying attachments. It is probably the most popular procedure and avoids long scars and scalp numbness. However, because it raises the hairline, proper patient selection is important.
Finally, there are several less involved procedures that are sometimes employed. There is the Browpexy which suture fixates the eyebrow at a higher level through an upper blepharoplasty incision. Obviously, it is most commonly performed when a blepharoplasty is planned and only minimal brow elevation is sought. Because nerves and blood vessels exit the forehead bone on the medial or inner aspect above the eyebrow, only lateral brow elevation can be accomplished using this technique. And lastly, there are less effective but occasionally employed “cable” procedures. These utilize sutures placed through incisions in the scalp above the eyebrows which go under the forehead skin to lift the eyebrows.