A number of men who think that they need upper eyelid surgery are in fact better treated with a browlift for the low hanging brows may be the esthetic problem. In addition, low hanging brows can cause visual field obstruction if severe enough. Associated findings with low brows can include prominent horizontal forehead wrinkles due to the action of the forehead muscles in an attempt to hold up the eyebrow, as well as deep vertical furrows or “anger lines” between the eyebrows. In women the most common techniques are the direct lateral approach, where a 4 cm to 5 cm incision is made in this hair bearing region, one on each side behind the frontal temporal hairline, and then the tissue is pulled out, thus elevating the brows. The other common technique is the endoscopic technique, once again where incisions are made within the hair-bearing scalp but they are much smaller incisions which accommodate the elevation of the brows through endoscopic or telescopic dissection. In men with balding patterns, these are not cosmetically acceptable due to the presence of scarring. A common technique that I utilize in men with hair loss to elevate the brows is the mid forehead brow lift in which 3 separate horizontal incisions are made through horizontal skin creases. These are direct approaches to elevate the brows and they provide outstanding elevation with relatively limited surgery and can be performed under straight local anesthesia. The basic downside of the procedure is that it takes approximately 6 to 8 weeks for the incisions to heal and be undetectable. During this time the patient can apply a little bit of concealer make-up and after 6 to 8 weeks, once the incisions are healed, the forehead is smoother, the fine line incision scars appear as a horizontal wrinkle, and the overall appearance of the upper face region/brow region is improved.
Posted by Jeffrey S. Epstein, MD, FACS
