Dr. Hamas (rhymes with “famous”)
Certified by the American Board of Plastic Surgery
Over 25 years experience
Inventor of the IDEAL IMPLANT®
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. 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 technical advances like these, eyebrow lift is a popular cosmetic surgery procedure for rejuvenating the face.
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.
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 of prominent facial expressions which raise the eyebrows repeatedly often in the course of conversation, etc. This repeated contraction of the muscles and folding of the skin results in creases. 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 are used subconsciously and repeatedly to hold them up. An eyebrow lift procedure lets these muscles relax, so the skin is not repeatedly folded and the horizontal creases diminish.
What about Botox or Dysport for forehead lines?
Botox and Dysport are neurotoxins injected into the muscles of facial expression to temporarily paralyze them. It must be repeated since it lasts for only a few months. If your corrugator muscles are surgically removed, you will not need repeated injections. See more information about injectables here.
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 use an endoscope, which is a miniature 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 prefer not to have their hairlines moved back at the time of an eyebrow lift.
In all open or coronal eyebrow lifts, the hairline is raised as the eyebrows are lifted. 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 at the hairline. The eyebrows and forehead tissues are lifted, but the hairline is not raised.
I have taught 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 forehead muscle layer to hold the eyebrows in their elevated position. After a short time, the entire elevated forehead heals, maintaining the lifted position of the eyebrows. Sutures work well for this, as they do for facelifts, etc. There is no need to place pins or screws into your skull to hold the eyebrows in their elevated position.
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 hairline 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 those 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.
If you're not ready for a facelift, but you still want the fresher, more youthful appearance that comes with reducing lines and wrinkles, injectables may be right for you.
Dysport® botulinim toxin is great for reducing forehead lines and crow's feet. (In a head-to-head test, Dysport was rated as "more effective at reducing crow's feet lines, while smiling, than Botox." Source). Restylane®, a filler, adds volume and fullness and to correct facial wrinkles and folds, such as the lines from your nose to the corners of your mouth. Sclerotherapy is available to treat visible red and blue veins.