There are multiple surgical methods for performing a brow lift. The best technique will depend on a patient’s aesthetic needs, individual anatomy, and the surgeon’s preference. Conventional techniques requiring large incisions across the scalp have fallen out of use to give way to newer, minimally invasive operations such as endoscopic lift.
The following are the most important steps involved in an endoscopic brow lift procedure:
Markings:
Before beginning the operation, the surgeon marks the areas where the incisions will be made. This step is very important because it will determine brow position.
For an endoscopic brow lift, several small incisions are marked about one centimeter behind the hairline, well hidden in the scalp. The location of the incisions varies slightly between men and women. In females, the markings are designed so that the results create an arched brow, while in males, the aim is to maintain the characteristic horizontal contour (T-shaped brow). In balding men, the central incisions are marked parallel to the horizontal forehead wrinkles to achieve inconspicuous scars.
Surgical markings dictate the rest of the operation. Well-placed markings are the initial step to a successful outcome, while poorly designed marks can negatively affect the results of a beautifully executed operation.
Anesthesia:
Most cosmetic brow lift operations are either done with intravenous sedation or with general anesthesia. The selection depends on several factors, such as patient preference, the estimated length of the surgery, and the anesthesiologist’s judgment.
Local anesthesia with diluted epinephrine is injected into the incision sites before starting surgery to decrease bleeding and facilitate dissection. This step is done when the patient is already sedated to ensure a painless procedure.
Raising the brow:
The surgeon makes the incisions in the desired locations, taking extra care not to damage the delicate hair follicles. To visualize the wound, hair is moved aside rather than cut or shaved.
The surgeon performs a meticulous dissection from the scalp down to the eyebrows. A camera, known as an endoscope, assists in the visualization of the correct plane and makes the operation safe and efficient. At this stage of the operation, the muscles responsible for frown lines are carefully spread apart and weakened. Then, the brows and forehead are raised to the desired position, preserving symmetry and natural contour.
Brow fixation:
The eyebrow/forehead unit must be fixated to the desired height until the tissue adheres to the cranium permanently. This process takes about 6 to 8 months; during this period, an internal brow fixation mechanism will prevent brow descent.
The surgeon has numerous fixation methods at his disposal. The bioabsorbable Endotine fixation device is perhaps the most reliable and safe, offering a lower probability of slippage of the tissues after the operation. This system maximizes fixation strength and allows for a minimal scar once the healing is complete.
Closing the incisions:
The final step of the brow lift operation consists of carefully opposing the wound edges to result in the least visible scar. The hair is thoroughly washed with an antibacterial solution, and a forehead dressing is applied for 24 hours.
|