The brow is an important structure because of its close relationship with the upper eyelid. Aging results in descent of the brow. This causes skin laxity in the upper eyelid area, causing hooding of the double eyelid crease, effectively aging the upper eyelid. Patients invariably notice this problem and are annoyed by it, but often attribute it to loose and excess skin the upper eyelid, when in fact the problem is due to sagging of the brow. To address this problem effectively, a browlift is required, not an upper eyelid procedure such as an upper blepharoplasty. By reversing the sagging of the eyebrows, the aging effects on the upper eyelid are corrected.
Dr Huang performs two kinds of surgical browlift: the endoscopic browlift, and the direct browpexy.
This is a minimally invasive, keyhole procedure performed through five small (2 cm) scalp incisions along the frontal hairline. All the scars are thus hidden within the hair bearing scalp. No shaving or cutting of the hair is required. A high definition fiberoptic camera system is inserted through the small incisions, allowing direct and magnified visualization of the relevant anatomical structures.
The scalp is separated from the forehead bone, after which the deep tissues are carefully released along the brow bone area, identifying and protecting important sensory nerves in the vicinity. This allows the brow to be elevated to a higher position. The brow is then stabilized in this new position with a special device known as an Endotine. The Endotine device keeps the brow in the elevated position and dissolves and disappears 6 to 12 months later, by which time the brow has set and stabilized in its new position. The scalp wounds are closed with special skin staples. The procedure is usually completed in 1 to 1.5 hours under intravenous sedation as a day surgery procedure.
DIRECT BROWPEXY WITH INFRABROW SKIN EXCISION
In this technique, an incision is made along the lower margin of the eyebrow. The incision is made in such a way that the resulting scar is hidden in the eyebrow hair, thus becoming virtually invisible. Excess skin below the brow is then removed if required. The area above the brow is carefully dissected, avoiding injury to sensory nerves in the vicinity. Bleeding is meticulously controlled. The lower wound edge is then stitched to the soft tissues overlying the brow bone above. This elevates the brow. The wound is then repaired with two layers of sutures, the skin being closed with multiple fine sutures. This ensures a fine, inconspicuous scar. This procedure takes about two hours ad is usually completed under local anesthesia or intravenous sedation as a day surgery procedure.
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