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Robert S. Hamas, M.D.
8345 Walnut Hill Lane
Suite 120
Dallas, TX 75231
(214) 363-1073
(214) 890-7844 (fax)

In some people, the forehead and eyebrows relax and droop even before the eyelids or face. This may be due to genetic factors, diminished elasticity from sun damage, or excessive movement of the forehead muscles. These muscles are used frequently in facial expressions such as squinting, showing surprise, frowning, laughing, concentrating or talking. As the muscles beneath the forehead move, the skin and tissues repeatedly fold, wrinkle and stretch.

As a result, the eyebrows fall into a lower position, especially on the sides. This can make you look tired or even mean. Also, as your eyebrows droop, skin is pushed onto your upper eyelids giving them the appearance of having excess skin and further adding to your tired look.

Lifting the eyebrows to a normal position opens your eyes and makes you look alert and rested. Lifting the eyebrows literally "opens the face." Surprisingly, a small amount of eyebrow elevation can make a big improvement in your appearance. Using a new technique described here, it is not necessary to lift your eyebrows so much that you look surprised or pulled, and it is not necessary to have your hairline raised. In fact, I developed the minimal incision eyebrow lift technique that prevents elevation of the hairline and the minimal incision technique for removal of the muscles that cause frown lines. Because of recent technical advances like these, eyebrow lift is fast becoming one of the most popular cosmetic surgery procedures for rejuvenating the face.

What about the horizontal creases?

Horizontal creases in the forehead result from repeated folding of the skin as the underlying muscles contract to lift the eyebrows. There are two reasons for this to occur and either or both may play a role.

The first reason is because the facial expression of raising the eyebrows is repeated often in the course of conversation, etc. This repeated contraction of the muscles and folding of the skin results in creases. In this case, an eyebrow lift procedure will not change the pattern of a person’s facial expressions, so the horizontal creases will remain.

The other reason is because the eyebrows are drooping low and the muscles subconsciously and repeatedly contract to hold them up. In this case, an eyebrow lift procedure lets these muscles relax, so the skin is not repeatedly folded and the horizontal creases diminish.

What about frown lines?

Vertical frown lines result from folding of the skin as the underlying corrugator muscles repeatedly contract pulling the eyebrows inward. This tends to occur if you subconsciously frown while concentrating or intently listening. Such a frowning expression is undesirable because it makes you look mean and angry. It gives the wrong message to those who work and live around you.

During an eyebrow lift, most of your overactive corrugator muscles are removed to reduce most of your subconscious tendency to frown. As a result, the skin folds less and the frown lines diminish and soften over time. This part of the procedure does not raise or lower the position of your eyebrows.

Though removal of the corrugator muscles is usually done as part of an eyebrow lift, it can also be done as a separate procedure if the eyebrows are already in a good position.

Collagen injected into the skin temporarily hides lines. This must be repeated every few months because the collagen is absorbed.

Botox is a neurotoxin injected into the muscles of facial expression to temporarily paralyze them. It also must be repeated since it lasts for only a few months.

Skin resurfacing is usually done with a laser to remove fine lines due to sun damage. It does not help frown lines and horizontal creases due to repeated facial expressions by the underlying muscles.

How is an eyebrow lift performed?

Some surgeons still perform eyebrow lifts through an incision across the top of the head from ear to ear. This open or coronal approach may follow along the front of the hairline. The disadvantages of this older technique are the long incision, cutting the sensory nerves to the scalp and a direction of lift that tends to be somewhat lateral, pulling the eyebrows to the sides.

Minimal incision eyebrow lifts have rapidly gained in popularity in recent years. Incisions are kept small by using an endoscope, which is a miniature telescope with a camera viewing system. It is much like that used for knee and abdominal surgery. Besides small incisions, this technique avoids the sensory nerves to the scalp and permits better control of the direction of lift.

If excess upper eyelid skin is also present, an upper eyelid lift can be done at the same time as the eyebrow lift.

What happens to your hairline?

This is the big issue that differentiates the various eyebrow lift techniques. Most women, and all men, prefer not to have their hairlines moved back at the time of an eyebrow lift.

In all coronal eyebrow lifts, the hairline is raised as the eyebrows are lifted. Placing the incision along the hairline prevents this, but leaves a visible scar along the hairline.

All endoscopic eyebrow lifts also raise the hairline except for the technique I developed in 1994. In this technique, only one small incision is made just behind the hairline. The eyebrows and forehead tissues are lifted, but the hairline is not raised.

I have been invited to teach my endoscopic eyebrow lift technique at many endoscopic training courses for plastic surgeons. My instructional videotapes on this procedure are in the library of the Plastic Surgery Educational Foundation and the Aesthetic Surgery Video Journal. The American Society for Aesthetic Plastic Surgery honored me with an award for my presentation on the endoscopic eyebrow lift. Also, my work has been recognized by the Canadian Society for Aesthetic Plastic Surgery with an invitation to demonstrate my endoscopic eyebrow lift procedure in Canada.

What is the direction of eyebrow lift?

For a natural result, it is very important to lift eyebrows in a mostly vertical direction to counter the effects of gravity. I do not use a lateral pull because that moves the eyebrows to the sides, spreads them apart, and leaves an unnatural appearance.

Lifting your eyebrows will leave your upper facial area looking more rested, natural and youthful. Your eyes will look more open, but not startled or surprised.

Subconscious frowning expressions will be diminished by removing most of your corrugator muscles. Over time, your vertical crease lines will soften and diminish.

How are the eyebrows held in place?

I use absorbable sutures in the muscle layer to hold the eyebrows in their elevated position. After a short time, the entire elevated forehead heals directly to the skull, maintaining the lifted position of the eyebrows. This suture technique works great. There is no need to have pins or screws put into your skull to hold the eyebrows in place as some surgeons do.

How are the corrugator muscles removed?

The majority of the corrugator muscle fibers are removed by looking through the endoscope and using tiny instruments. When done at the time of an eyebrow lift, the same small central incision is used.

If the corrugator muscles are being removed without an eyebrow lift, three 1/4-inch incisions are placed along the hairline.

What happens after surgery?

A dressing on the head and a small drain tube are removed the next day so you can shower and shampoo your hair. Mild pain medicine is needed for the first two or three days, particularly at bedtime. Keeping the head elevated the first four to five days helps reduce swelling, which is gone by about two weeks. Bruising usually resolves by 10 to 14 days.

Most patients feel comfortable out in public with some make-up by about seven to 10 days. You may resume light activities similar to that in an office by three or four days and full athletics without restriction by two weeks.

What are the risks of eyebrow lift and corrugator muscle removal?

Some of the risks include infection, bleeding, altered sensation and asymmetry. These will be discussed in detail during your consultation.

Where is the surgery done?

Cosmetic surgery is done in my own accredited office operating room facility. Click here for more information.

Is there financing?

You may wish to use your VISA or MasterCard to pay for your surgery. Should you desire a personal loan, your own bank or credit union is your best source since they are already familiar with your credit history. If you prefer, the office will recommend a source for financing your cosmetic surgery.

For more information, or to schedule a personal consultation, call 214-363-1073

Robert S. Hamas, M.D.
8345 Walnut Hill Lane, Suite 120
Dallas, Texas 75231

Certified
American Board of Plastic Surgery

A Complete Guide to Cosmetic Surgery