Drooping of the eyebrows is frequently one of the first signs of aging. This condition is often overlooked because most patients are unaware of the problem and the degree of improvement its correction can provide (Fig. 19.1).
A heavy eyebrow causes the upper lids to drop or descend until, in the advanced stages, eyelid skin can touch or overlap the eyelashes.
Patients often complain that their eyes appear to be getting smaller or deeper set and that (in women) eye makeup usually ends up high on the upper part of the lids within a short while after it has been applied. Drooping eyebrows definitely contribute to the dreaded “tired look.”
In some cases, a patient’s subconscious need to contract muscles in the forehead to lift a drooping brow can contribute to headaches. I explain this phenomenon in the following manner: Any muscle that is contracted over a protracted period of time fatigues. Fatigued muscles often cramp. And a cramp in the area of the forehead is called a “headache.” Surgical eyebrow lifting can alleviate or reduce (on a long-term basis) the incidence of headache precipitated by a drooping eyebrow. Neuromodulators can do so on a temporary basis. And, on the subject of headaches, Chapter 12 (Nasal Plastic Surgery: Rhinoplasty) addresses an often unrecognized and correctable cause of headaches— impaction of the nasal septum against a turbinate.
Browlift surgery may be incorporated into forehead lifting. In men, I usually prefer direct excision of a measured section of skin above the drooping section of the brow. The excision lines used to remove forehead skin are placed on either side of (but not within) the most prominent rhytids in the forehead and beveled so that closure everts the skin edges (Fig. 19.2)
Following surgery, the wound is cross-taped in an antitension manner for a week. Sutures are removed at that time and the wound is retaped for another week. Patients are instructed on how to apply antitension taping each evening before going to bed and anytime they are “around the house” for the day. If antitension taping is appropriately applied for 4 to 6 weeks, the scars are generally imperceptible. In fact, they are usually less noticeable than the rhytids that were incorporated within the section of skin removed.
Fig. 19.1 (a) Heavy or low-set brows can give one a “tired” or “stern” look, (b) but a browlift can restore them to their proper position, resulting in a more alert and youthful appearance. The incisions in this direct browlift are immediately above the brow hairs but are easily camouflaged.
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