Part 3 – Improving the appearance of your forehead, eyelids and eyebrows: Surgical Treatment Options

So far in this series of articles, we discussed why and how the forehead, eyebrows and upper eyelids age over time.  We spent some time discussing some temporary non-surgical treatments such as Botox and skin tightening. Now we will discuss some more permanent and long-lasting solutions for the eyebrows, upper eyelids and forehead.

Typically, people who come to see a plastic surgeon or a cosmetic surgeon are often concerned about a “tired” look to their eyes. Referring to Part 1 of this article series, you may recall that your forehead, eyebrows and upper eyelids are all one large unit and have a very intimate connection. In fact, people are often surprised when I tell them that the best solution for their upper eyelids is to elevate or stabilize their forehead. So, how do we do this?

The forehead and eyebrows have a very complex anatomy. I will not spend time discussing the details of this as it takes surgeons many years to master and understand the anatomy of the forehead and eyebrows. Rather, I will discuss a number of options that are available for elevating and stabilizing the eyebrows and forehead.

The first question we need to answer is, does the person have evidence of balding or thinning hair? If yes, this limits our choices as many of the surgical options leave scars. However, people with a full head of hair are better able to hide these scars and thus there are more options available to choose from. It is important to note however, that just because a person is balding or has thinning hair, it does not mean they cannot benefit from a surgical procedure – it just means the options are limited and cosmetic surgeons need to get more creative if they wish to avoid noticeable scarring.

For people with a full head of hair, there are three common choices for eyebrow and forehead surgery.

• Endoscopic Forehead lift
• Coronal Forehead Lift
• Trichophytic Forehead Lift

The endoscopic lift involves five incisions hidden within the hair. These incisions are well hidden. The surgeon then uses a camera to perform the surgery. The result of this surgery is typically excellent and often helps to both stabilize and elevate the eyebrows. This, as we discussed in Part 1, can also improve the upper eyelids.

The Coronal Forehead Lift is often used for people with a high forehead. The reason for this is that you can lift the forehead and remove some extra skin, thus decreasing the distance between the eyebrows and the hairline. The downside is that there is a very long incision and therefore a potentially visible scar that runs across the forehead. This is a very effective and powerful technique, but as mentioned, the scar it leaves often prevents people from using it.

The third common option is the Trichophytic Forehead and Eyebrow Lift. Although it may sound fancy and complicated, it is simple to understand when you consider the goal of this surgery. This lift involves making an incision immediately behind the hairline so that when the scar forms, hair grows through the scar and helps to hide it. This procedure is a very reliable technique, however if the hair does not grow through the scar, it can be visible at times.

What about those with very thin hair or who are balding? As mentioned, other options for rejuvenation of the forehead and eyebrows exist. They include the Direct Eyebrow Lift or the Indirect Eyebrow Lift. A Direct Eyebrow Lift involves making an incision at the edge of the eyebrow, removing extra skin and stitching the eyebrow higher on the forehead. An Indirect Eyebrow Lift involves making an incision within a deep wrinkle on the forehead so that the scar is hidden within the wrinkle itself. These techniques often can achieve excellent results; however they are often slightly less effective than the previously mentioned surgeries.

Finally, how can we improve the upper eyelid skin? Well remember, after performing a forehead lift cosmetic and plastic surgeons can now assess and determine how much upper eye lid skin remains. If extra skin remains, we can perform a Blepharoplsty (removal of the extra eyelid skin). This is a safe procedure that allows us to reduce the extra skin and improve the appearance of the upper eyelid.

Together, these surgical procedures are very effective and long-lasting. However, it is important to remember that you will continue to age, and eventually the skin will start to loosen. Over time, the eyebrows will drop, resulting in some loose eyelid skin. However, the above discussed surgical procedures are typically dramatic and long-lasting.

Hopefully this series of articles has helped improve your understanding of the aging forehead, eyebrow and upper eyelid and the cosmetic surgical procedures available, such as a forehead lift and blepharoplasty, which can help reduce the signs of aging.