Aging of the forehead can cause the eyebrows to fall with hooding of the upper eyelids, resulting in a full, heavy, tired look that makes the eyes look smaller. Forehead grooves and frown lines accentuate the problem by making a person appear angry or fatigued. In patients with good brow position, removal of only the excess skin of the upper eyelids will provide the ideal result. However, in patients with low eyebrows, the best results will be achieved by elevating the brow position with or without removal of excess upper eyelid skin. It does not create an abnormal “Surprised” look, rather, one of remarkable facial rejuvenation. Although incisions to lift the brows can be made at the upper border of the eyebrow or in the forehead creases, some doctors prefer to make them within the hair of the scalp (in patients with a low hairline), where it is totally hidden by the surrounding hair, which is not shaved. Because the hairline is slightly raised with this approach, this is the ideal technique in all women except those with a very high forehead. For most women, the surgeons have developed a procedure to camouflage the incision within the hairline and simultaneously within lower it. In men, however, where there is concern about baldness, the incision in the front of the scalp could be visible. Therefore, the brow lift may be done in conjunction with hair replacement surgery or through one of the previously mentioned alternative incisions. The forehead–eyebrow lift also lessens forehead creases and frown lines between the eyebrows.
Procedure Both the forehead or eyebrow lift can be performed at the same time as eyelid surgery depending upon the needs of the patient. Postoperatively the patient will wear a dressing for one day. This procedure may cause temporary swelling and bruising around the eyes. There is a temporary loss of sensation in the scalp, but this resolves with time. Insurance may cover this procedure and upper eyelid surgery when vision is compromised due to excess skin. Frequently consultation with an ophthalmologist is necessary to determine the extent of impaired vision.