The eyebrow and forehead area are one of the places that show earliest signs of aging. Constant use of forehead muscles, gravity, loss of skin and muscle tone, and sun exposure all contribute to changes in the natural elevation of the eyebrow. Neuromuscular paralyzing agents like BOTOX® Cosmetic and Dysport® have been used to treat forehead wrinkling and lift the eyebrow temporarily. However, these measures are not a permanent fix and do not address wrinkling over the bridge of the nose. Severe drooping of the eyebrows can lead to excessive eyebrow skin accumulating in the upper eyelid. During the consultation, Dr. Selem will discern excessive upper eyelid skin from excessive eyebrow skin, an important distinction because of the possibility of complications that can arise from excising eyebrow skin above the eyes. When excessive eyebrow skin accumulates over the eyelashes and obscures vision, it is deemed a medical necessity to restore lost vision. Thus, insurance will reimburse for treatment.
With recent advances in plastic surgery techniques, we’ve moved away from the once popular coronal brow lift, where the incision was placed from ear to ear in order to adequately elevate the forehead and eyebrow. Unfortunately, patients complained of loss of sensation, loss of hair, and an unsightly scar left by this procedure. Dr. Selem offers a novel procedure that allows the brow to be lifted through minimal incision endoscopy and a unique “invisible incision” internal brow lift. Using an incision through the upper eyelid crease will provide outstanding results without an unsightly scar above the brow.
Using 2 small incisions within the hair-bearing portion of the scalp, a special scope is inserted for visualization of the dissection. The brow is then lifted and held with permanent sutures under the skin. Surgical clips are used to close incisions and are removed 14 days after surgery. This procedure takes approximately 1 hour and a pressure bandage is used on the forehead for 2 days.
The temporal brow lift uses two incisions approximately 1 cm in length parallel to, and 1 cm behind, the hairline in the temple. Dissection then proceeds down to the deep temporal fascia where specialized designated instruments are used to elevate the temporal forehead. This lift will address wrinkles at the corners of the eye (crow’s feet) making the need for BOTOX® Cosmetic or Dysport® unnecessary. Surgical clips are then used to close the incision and then are painlessly removed 14 days after surgery. A pressure bandage is then left on the forehead for 2 days. This procedure takes approximately 1 hour.
Dr. Selem uses the natural upper eyelid crease to place the incision so that it remains inconspicuous. After removing excessive eyebrow fat pads, Dr. Selem will be able to internally fixate the eyebrow to an aesthetically pleasing position. The incision is closed using absorbable sutures that dissolve in 7-10 days. An upper eyelid blepharoplasty is combined with this procedure to remove unwanted excessive upper eyelid skin.
The procedure takes approximately 90 minutes and can be performed in the office with the patient under local anesthesia, or at an outpatient surgical facility with sedation. A 1 cm thick contact lens is placed to protect the eyeball. Patients should anticipate swelling and bruising for 7-10 days after brow surgery. Ice-packs will be placed over the eyes during the first 24 hours. Sutures used are self absorbing and dissolve 7-10 days after the procedure. Patients are seen at 1 week and 2 weeks after the procedure for their post-operative appointments.
Dr. Joseph Selem and the staff at The Selem Center for Ophthalmology & Plastic Surgery would be happy to help you set up a private consultation to discuss brow surgery. Schedule an appointment online or call us at 305-444-0221.