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coronal
browlift (coronoplasty or headband incision)
: The coronal method of brow lift surgery (coronal
means crown-like) uses an incision from ear to ear to
lift the forehead and then remove excess skin from the
scalp. Since the entire forehead flap and all of the
muscle and bone are easily visible, this is technically
the simplest browlift to perform. The coronal incision
will lengthen the forehead and raise the hairline as
the forehead is lifted. This is beneficial for someone
with a short forehead, but not desireable in patients
with an already long forehead. The coronal lift is not
commonly the preferred method anymore due to hair loss,
numbness, scarring and a greater recovery time.
endoscopic
browlift (also referred to as "endobrow")
: Using a tiny camera and long instruments
inserted through 5 or 6 small incisions in the scalp,
the forehead is separated from the bone and lifted.
Sutures, screws, or staples are used to hold the forehead
flap in place for a few weeks while it heals so that
it does not slip back down. (see fixation techniques
below) No skin is removed with the endoscopic technique,
so this is not the best approach with someone with alot
of excess forehead skin and wrinkling. Loss of sensation
is minimal, especially when compared to the persistent
numbness following the coronal lift (see above). Minimal
scarring does make it beneficial for men with little
or no hair to cover the scars.
temporal
or lateral browlift : With a temporal or
lateral browlift, the incisions are placed within the
hair-bearing areas at the temples towards the side of
the face. Excess skin is removed, lifting the outer
corners of the brow. This method will not raise the
middle of the brow, but it can help to alleviate crow's
feet (wrinkling at the corners of the eyes) somewhat.
The temporal browlift is ideal for patients whose only
concern is drooping of the tail of the eyebrow. It can
also be done in conjunction with an endoscopic browlift
or with a facelift.
mid-forehead
browlift : Using the midforehead browlift method,
an incision is made in a deep wrinkle in the middle
of the forehead. Sometimes more than one incision is
placed in different furrows. (These deep furrows are
a result of involuntary forehead muscle contraction
to raise the drooping eyebrows). The brows are then
lifted, and excess skin removed. With careful suturing,
the scar will disappear into the crease once it has
healed. This procedure is best for men with heavy foreheads
and deep wrinkling, and is useful in men with an already
high hairline since this technique will lower the hairline.
direct
browlift : With the direct browlift, the
incision is placed immediately above the brows and follows
the natural curve of the eyebrow. Like the midforehead
lift, it will not raise the hairline. With careful surgical
techniqe and meticulous suturing, the scars should be
barely noticeable.
pretrichial
or hairline browlift : By definition, the
incision for a pretrichial or hairline browlift is made
in front of the hariline at the top of the forehead,
although in practice the incision is usually a few millimeters
into the hairline. The forehead and brows are lifted,
and excess skin is removed. This procedure works well
for someone who has a full head of hair, and who does
not want the longer forehead or higher hairline that
will likely result from a coronal or endoscopic browlift.
The scar may be visible in patients who wear their hair
pulled back off of the face.
trychophytic
browlift : Similar to the pretrichial lift, but
the incision is just barely within the hairline (as
opposed to the pretrichial where the incision is by
definition just barely outside of the hairline).
transpalpebral
browlift : The transpalpebral browlift is
performed through incisions made only in the upper eyelid
creases. This technique is useful in bald men who do
not require skin removal and mostly desire a permanent
weakening of the brow and forehead muscles, rather than
a lift. The transpalpebral incison can also be used
for corrugator muscle excision (see below) and brow
bone reduction (see below).
corrugator
muscle excision : The corrugator is the muscle
that allows your eyebrows to squeeze together when your
frown or worry. Either as a procedure by itself or in
conjunction with a browlift, removing part of the corrugator
muscle will yield a more relaxed appearance and inability
to create lines between the eyebrows. The result is
similar to having Botox injections between the eyebrows,
but the results of corrugator excision are usually permanent.
In some instances, cutting out too much muscle can cause
visible contour irregularities or depressions from where
the muscle was taken. If corrugator excision is done
with a browlift, the incision is placed within the crease
of the eyelid.
brow
bone reduction : also known as orbital
rim contouring or brow shave. (This is not a browlift,
but is another option in shaping the brow and forehead).
Brow bone reduction is used to minimize the appearance
of deep set eyes, or for men desiring more feminine
features. Orbital rim reduction involves burring down
the brow bone to make it less prominent. This can be
done through an incision in the upper eyelid crease,
or through an incision in the scalp (such as the coronal
browlift incision). The procedure can be performed with
IV sedation. The greatest risk is of contour irregularities,
but nerve damage or frontal sinus damage can also occur.
This surgery should only be done by a doctor experienced
with this procedure.
brow
fixation : In some patients, removing upper eyelid
skin without fixating the brow will result in further
brow descent and a recurrence of upper eyelid hooding.
In this case, the patient will be concerned a few months
after surgery that the doctor did not remove enough
skin because the brows are being pulled down. To prevent
this, a procedure is done similar to a browlift, but
without raising the eyebrows. As the forehead
flap heals, it will adhere in it's new position, anchoring
the eyebrows and preventing brow drooping with upper
eyelid surgery. Most people do not need brow fixation,
but careful examination and observation is required
by the surgeon to detect this before surgery.
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