Dr. Blake Raggio, Facial Plastic & Reconstructive Surgeon
Beauty and the Brows
You may recall from some of my earlier articles, Cosmetic Surgery Amongst Baby Boomers and Anatomy of Facial Aging, where I discussed not only the increasing prevalence of facial cosmetic procedures amongst the aging population, but also the reasoning behind what happens to the face as one gets older. Over the next few months, I’ll be focusing my discussions on certain key areas of the face that can be improved with both surgical and non-surgical options. This month I’d like to discuss the topic of eyebrow rejuvenation by answering some frequently asked questions regarding how to best treat this often-overlooked area of the upper face.
Remind me again, what happens to the brows as we age? In short, the brows should rest just at or above the bony orbital rim, or what some may call the forehead bone. With age, the brows descend or become ptotic (droopy) due to a combination of factors, namely the weakening of various retaining ligaments of the skin and surrounding structures. This loss of structural support, in association with the downward pull of gravity, are responsible for the sad, tired, or angry look often associated with a descended brow. Furthermore, a droopy brow has more than just cosmetic consequences, as it can exacerbate an already heavy upper eyelid and contribute significantly to both cosmetic and functional changes associated with the upper eyelids. I am interested in treatment – What are my options? In the most basic sense, two categories of treatment exist: surgical and nonThe River Region’s 50+ Lifestage Magazine
surgical. In the surgical realm, the procedure is called a brow lift (i.e., forehead lift), which can be accomplished via a variety of surgical techniques ranging from minimally invasive approaches (via endoscopes) to more traditional open techniques. Regarding non-surgical options, a modest lift of the brow can be performed using botulinum toxin (Botox, Xeomin, Dysport) and/or dermal fillers (Juvederm, Restylane, RHA) to help relax muscles pulling down the brow and to provide underlying support, respectively. Recently, there has been a resurgence of thread lifts (i.e., suture lifts) using a variety of absorbable materials to help suspend a droopy brow, though their efficacy and durability remain controversial. Lastly, there exist several energy-based devices (e.g., Ultrasound, Radiofrequency) that tout minor elevation to the brows though evidence to support their claims is weak at best. Overall, more subtle improvements can be achieved with Botox and fillers, whereas more dramatic changes will require a surgical procedure. At what age is a brow lift usually required? There is really no age requirement for a brow lift. For instance, some patients in their early 30’s who suffer from a congenitally low-set brow may benefit from a modest lift using non-surgical techniques (Botox, Fillers); On the other hand, patients who acquire a droopy brow secondary to age—typically
noticeable in their 40’s and 50’s—often benefit from a surgical browlift usually performed via a minimally invasive approach or open techniques, depending on the severity of the brow droop. Is a brow lift covered by insurance? A non-surgical brow lift is not covered by insurance. However, if you are interested in a surgical brow lift, you might be surprised to hear that your insurance may cover the procedure, but only if the brow descent is caused by a facial paralysis and/or contributing to a problem with your vision. This visual deficit can be easily confirmed via a quick visual field test done by your local ophthalmologist (eye doctor). How can I learn more about a brow lift? If you are interested in learning more about brow rejuvenation to correct a tired, sad, or angry appearance to the upper face, I suggest consulting with a physician experienced in both surgical and nonsurgical brow lift techniques so that you receive a thorough and non-biased evaluation. As always, choose a surgeon whom you trust. There is nothing more important than the relationship you have with your doctor. Until Next Time. Dr. Blake Raggio Facial Plastic & Reconstructive Surgeon Alabama Plastic and Reconstructive Surgery 334-270-2003 Dr.Raggio@ALplasticsurgery.com www.ALplasticsurgery.com R ive r Re gio n Bo o m . co m
May 2021
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