Over the years, many procedures have been developed to address the droopy brow. Two of the most common techniques are the endoscopic brow lift and the transfollicular subcutaneous brow and forehead lift.
Our preference in treating the droopy brow is the transfollicular subcutaneous brow and forehead lift, also known as a mini open brow technique. This technique is appropriate for the majority of patients.
Normally, the youthful female brow is located above the superior orbital rim, with the lateral component elevating upward, residing 5-10 mm above the lateral orbital rim. The youthful male brow is typically located at the orbital rim.
Once the diagnosis of a droopy brow is made, your unique anatomy, sex and expectations will determine which technique will be best for you.
Some of the benefits of the transfollicular subcutaneous brow and forehead lift is that it does not result in hairline elevation, which is especially important for women and men who may already have an elevated hairline.
Our transfollicular subcutaneous brow and forehead lift is a direct-vision procedure that we perform under local tumescent anesthesia with or without IV sedation. The wrinkles of the forehead are significantly reduced and the muscles that depress the brow can be weakened too. This improves some of the “ugly lines” in the middle and lower forehead.
We make the incision for this transfollicular subcutaneous brow and forehead lift just behind the hair line. The hairline follicles are purposely transected at an angle so that the fine hairs in the frontal hairline grow right thru the incision, making the incision virtually unnoticeable once it heals.
We remove a variable amount of skin with this mini brow lift procedure. Because the dissection is just below the skin, there is less swelling and a faster recovery than with the endoscopic brow lift. There is no need to place sutures or other foreign material directly into the skull bone with the mini brow lift, as is done with the endoscopic procedure.
The tension is spread across the incision with the mini brow lift, which is better for healing, as opposed to extreme tension placed on several key sutures with the endoscopic procedure. There is no cause to overcorrect with the mini brow lift as is needed in the endoscopic procedure, as the result, we see on the O.R. table with the mini brow lift represents the long term result of this procedure.
The mini brow lift can also be used to lower the frontal hairline by advancing the scalp forward, a desirable feature for many patients.
Generally, men have unstable frontal hairlines so the endoscopic procedure is preferable.
Most patients who present with a droopy brow also have excess upper eyelid skin which can be removed at the same time as a Transfollicular Subcutaneous Brow and Forehead Lift.