Commonly there is so much scalp and forehead relaxation that the eyebrow either hangs over the bony rim of the eye socket or is kept from doing so by constant contraction of forehead muscles. Sometimes the brow’s lower position is congenital or developmental. This makes additional stretching that comes with aging even more problematic. Restoring the eyebrow to a normal location and contour without having to contract the forehead muscles is critical to cleaning up the upper lid and restoring a fresh and youthful look to the upper part of the face. Sometimes this can be of immense help in very young people long before they would even consider a facelift. Elevation is sometimes indicated uniformly across the forehead; other times we want to raise the lateral brow more than the central brow. Rarely does the medial brow need more lift than the lateral brow.
The most common error in plastic surgery is the attempt to solve a forehead-brow problem by removing skin from the eyelids. It simply does not work and serves only to worsen the appearance. When upper eyelid skin is removed in patients who continuously raise their brows (in order to have unobstructed comfortable vision), the eyebrows will invariably drop to a lower level after surgery. The reason for this is that the overworked forehead muscle is able to relax at least partially, which drops the brow, but still allows the patient to see – so it does just that. This results in a lower position of the eyebrow and an exaggeration of the frown between the brows, causing older, more tired appearance with the patient looking angry as well.
Most of our brow lifts occur through the coronal approach across the top of the head or a modification thereof. The common modification is for male type balding (which also occurs in some women). Other brow lift operations involve hair margin incisions or removal of skin from just above the eyebrow, leaving a scar reaching out toward the temple hair. Our newer coronal type scars are rarely visible since they were moved backwards to the point where all the hair grows in the same direction. Because of easy access to the muscles of the forehead and eyebrow through the coronal incision, this is an excellent opportunity to make modification of the frown muscles. More often than not, when the forehead or coronal lift is performed, there will be some associated muscle operation.
Corrugator: These muscles are responsible for the deep frown creases between the eyebrows. The forehead or coronal lift is by far the most effective method of removing these muscles. No other incision provides such good exposure for adequate removal of corrugator muscles. Muscle removal is far better in all, except some patients prefer to have Botulism toxin (Botox) injected into the muscles for the temporary way to denervate the muscles for approximately six months. We offer Botox injections at our Clinic, but we believe that muscle excision is a more permanent solution.
Procerus: This muscle is responsible for the transverse creases at the root of the nose. The muscle may be removed during a coronal lift to reduce the prominence of these creases.
Frontalis: This is the large muscle, which is responsible for transverse creases across the forehead. Total removal of this muscle would destroy virtually all forehead animation – an undesirable feature. Therefore only portions are removed, simply raising the eyebrows off of the eyelids. This approach, especially when combined with proper upper lid surgery, eliminates or markedly reduces transverse forehead wrinkling without any frontalis muscle removal.
Our plastic surgery clinic is located in Panama City and Destin, on Northwest Florida's Emerald Coast.