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OCULOFACIAL-SURGERY

DROOPY BROWS

Often a heavy and droopy brow area can cause hooding of the upper eyelids resulting in a sad or tired appearance.  Depending upon the severity of the droop, there are effective non-surgical and surgical techniques that may help to restore the brows and forehead to a more youthful position offering a brighter and refreshed eye and forehead area.    Read More
Non-surgical Treatments for Droopy Brows
In some mild cases of droopy brows, botulinum toxins such as Botox® Cosmetic or Dysport® can be injected into specific muscles that are responsible for raising the eyebrows to help open up the eye area and provide a well-rested, natural result.  Botulinum toxin offers a temporary result that lasts 3-5 months and requires further treatment for continued results.
If a mild brow droop occurs at the outside edge of the brow area, then in addition to botulinum toxin, dermal fillers such as Juvéderm®, Restylane® or Radiesse® may be injected to lift the tip of the brow and open up the eye area.  Dermal fillers in the brow area may last from 6-months to over 1-year and require further treatment for continued results.
Surgical Treatments for Droopy Brows
If a brow droop is moderate to severe, then a brow lift (also called a forehead lift) is often the best option for surgical correction. In addition to raising the eyebrows for a more alert and youthful eye area, a brow lift also helps to smooth creases that develop across the forehead and soften frown lines that often appear high across the bridge of the nose and in between the brows (the 11’s).
Depending upon each patient’s specific anatomy and the severity of the brow droop, there are several surgical techniques that may be employed to achieve the desired result.
Endoscopic Brow Lift
The endoscopic brow-lift technique employs a small camera inserted into several small incisions created behind the hairline.  With the endoscope, the surgeon uses a small camera to  perform the surgery with smaller incisions than with traditional brow lift techniques.
During the surgery, the tissues are repositioned and secured at the optimal height using devices such as endotines, which act as resorbable anchors that support the brow in an elevated position. As the surrounding tissues heal, the body naturally absorbs the endotine fixtures without affecting the final surgical result.
TransBleph Lift
For those patients with thinning of the hairline or patients who could benefit from both upper eyelid surgery (blepharoplasty) and a brow lift simultaneously, a TransBleph procedure may be an appropriate option.  During the procedure, an incision in the crease of the upper eyelid is created, offering direct access to the brow.  The tissues are then repositioned as appropriate and an endotine TransBleph fixation device is placed on the surface of the forehead at the brow line to hold the repositioned brow in its new position.  Once healing is complete, the body naturally absorbs the TransBleph device, which is no longer needed to maintain brow position.   The TransBleph procedure is an effective combination procedure with an upper eyelid lift because the same incision can be used to remove or reposition any excess tissue of the upper eyelids.
Temporal Brow Lift
If the central portion of the brow area is well positioned but the outer edges of the brow droops, then a temporal brow lift may be an appropriate surgical option. The temporal brow lift technique is a procedure in which small incisions are made in the temple region of the forehead and scalp. Most of the incisions are hidden in the scalp with a small incision on the side of the forehead. The skin and tissue are then repositioned and sutured into position or held in place with endotine fixation devices, resulting in a more appropriately positioned outer eye area.
Direct Brow Lift
For those with a very heavy brow who do not mind their forehead furrows developed over years of expression, a direct brow lift may be an appropriate option to restore a more youthful appearance to the eye area.  A direct brow lift procedure entails making incisions above the brow line in the forehead and repositioning the skin and tissue to lift the brow area.  The incisions are usually created within a natural crease in the forehead or above the eyebrow so that any remaining scars are hidden after the healing process is complete.  A direct brow lift may also be appropriate for facial nerve palsy patients with asymmetric forehead furrows and brow ptosis, as the scars can be used to create symmetry in the forehead area.
A brow lift is often performed in conjunction with other surgical procedures such as an upper and/or lower blepharoplasty, a mid-facelift or full facelift depending upon the needs of the patient.  As an oculofacial surgeon, Dr. Elahi has extensive experience in identifying and executing the most appropriate procedure for each patient based on their anatomy and desired results.
Often a heavy and droopy brow area can cause hooding of the upper eyelids resulting in a sad or tired appearance. Depending upon the severity of the droop, there are effective non-surgical and surgical techniques that may help to restore the brows and forehead to a more youthful position offering a brighter and refreshed eye and forehead area.
Non-surgical Treatments for Droopy Brows
In some mild cases of droopy brows, botulinum toxins such as Botox® Cosmetic or Dysport® can be injected into specific muscles that are responsible for raising the eyebrows to help open up the eye area and provide a well-rested, natural result.  Botulinum toxin offers a temporary result that lasts 3-5 months and requires further treatment for continued results.  If a mild brow droop occurs at the outside edge of the brow area, then in addition to botulinum toxin, dermal fillers such as Juvéderm®, Restylane® or Radiesse® may be injected to lift the tip of the brow and open up the eye area.  Dermal fillers in the brow area may last from 6-months to over 1-year and require further treatment for continued results.
Surgical Treatments for Droopy Brows
If a brow droop is moderate to severe, then a brow lift (also called a forehead lift) is often the best option for surgical correction. In addition to raising the eyebrows for a more alert and youthful eye area, a brow lift also helps to smooth creases that develop across the forehead and soften frown lines that often appear high across the bridge of the nose and in between the brows (the 11’s). 
Depending upon each patient’s specific anatomy and the severity of the brow droop, there are several surgical techniques that may be employed to achieve the desired result.
Endoscopic Brow Lift
The endoscopic brow-lift technique employs a small camera inserted into several small incisions created behind the hairline.  With the endoscope, the surgeon uses a small camera to  perform the surgery with smaller incisions than with traditional brow lift techniques. 
During the surgery, the tissues are repositioned and secured at the optimal height using devices such as endotines, which act as resorbable anchors that support the brow in an elevated position. As the surrounding tissues heal, the body naturally absorbs the endotine fixtures without affecting the final surgical result.
TransBleph Lift
For those patients with thinning of the hairline or patients who could benefit from both upper eyelid surgery (blepharoplasty) and a brow lift simultaneously, a TransBleph procedure may be an appropriate option.  During the procedure, an incision in the crease of the upper eyelid is created, offering direct access to the brow.  The tissues are then repositioned as appropriate and an endotine TransBleph fixation device is placed on the surface of the forehead at the brow line to hold the repositioned brow in its new position. Once healing is complete, the body naturally absorbs the TransBleph device, which is no longer needed to maintain brow position.   The TransBleph procedure is an effective combination procedure with an upper eyelid lift because the same incision can be used to remove or reposition any excess tissue of the upper eyelids.
Temporal Brow Lift
If the central portion of the brow area is well positioned but the outer edges of the brow droops, then a temporal brow lift may be an appropriate surgical option. The temporal brow lift technique is a procedure in which small incisions are made in the temple region of the forehead and scalp. Most of the incisions are hidden in the scalp with a small incision on the side of the forehead. The skin and tissue are then repositioned and sutured into position or held in place with endotine fixation devices, resulting in a more appropriately positioned outer eye area. 
Direct Brow Lift
For those with a very heavy brow who do not mind their forehead furrows developed over years of expression, a direct brow lift may be an appropriate option to restore a more youthful appearance to the eye area.  A direct brow lift procedure entails making incisions above the brow line in the forehead and repositioning the skin and tissue to lift the brow area.  The incisions are usually created within a natural crease in the forehead or above the eyebrow so that any remaining scars are hidden after the healing process is complete.  A direct brow lift may also be appropriate for facial nerve palsy patients with asymmetric forehead furrows and brow ptosis, as the scars can be used to create symmetry in the forehead area.
A brow lift is often performed in conjunction with other surgical procedures such as an upper and/or lower blepharoplasty, a mid-facelift or full facelift depending upon the needs of the patient.  As an oculofacial surgeon, Dr. Elahi has extensive experience in identifying and executing the most appropriate procedure for each patient based on their anatomy and desired results.   

For more information, call 212-570-0707 to schedule a consultation with Dr. Elahi.
For more information, call 212-570-0707 to schedule a consultation with Dr. Elahi.
 

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