Obviously, one of the goals of a brow lift is to elevate the brows; otherwise, the surgery would be called something else. Since everyone's brows are the same with respect to size, shape and position, the procedures must be tailored to the wants and needs of each patient.
Medial Brow Elevation
Plastic surgeons argue what the best suspension technique is for fixation of the brows; however, it has been shown that with good release of the forehead muscles at the level of the brow, the inner (medial) ends of the brows tend to elevate without any fixation. Suspension in the form of a permanent sutures, temporary screws or bone windows may be used for more prominent elevation or to correct asymmetries.
Lateral Brow Suspension
Most patients who seek consultation for a brow lift are more concerned about the position of the other (lateral) ends of their brows. While sagging of the medial brow tends to give an angry look, sagging of the lateral brows results in a sad or tired appearance. It also displaces the skin on the upper eyelids downward, contributing to as aged appearance. Elevation of the lateral brow is also accomplished by muscle release at the brow level and suspension with permanent sutures further back in the scalp.
Differential Brow Elevation
In some patients, the goal is to elevate the entire brow equally so that the shape of the brow does not change, only its position. More commonly, an extra effort is made to elevate the lateral brow edges more than the medial brows, particularly in women to provide a more ‘awake’ look to the eyes. In patients who have a very flat brow, an effort can be made to elevate the middle portion of the brow more than the ends to give an arch to the shape of the eyebrow. Again, this is more commonly performed in women.
Obviously, there are limitations on what can be accomplished on any patient given the position of the brows as well as the length and convexity of the forehead. Every effort is made to provide an ‘unoperated’ look for a natural appearance. This may be more easily accomplished using the endoscopic technique rather than the open approach as excessive elevation almost to the point of a surprised appearance is more likely with the latter procedure compared to the former.
The area between the brows is known as the glabella where furrows develop when frowning. As the frown muscles are weakened by partial removal at the time of a brow lift, less wrinkling of the glabella occurs with facial animation after brow elevation surgery. As a result, this area tends to flatten and there can be a slight increase in the separation of the brows since the muscles used to draw them together (corrugator supercilii) have lost some of their strength. This can give somewhat of a relaxed appearance to the lower forehead and brow area following a brow lift procedure.