There are surgical and nonsurgical options when one wishes to improve the appearance of their brow and upper eyelids. Nonsurgical options are usually best for people who are seeking mild degrees of improvement. Botox can be injected in the strategic locations to achieve a "chemical browlift". In doing so, the eyes themselves, can appear more refreshed, and the lines between the eyebrows can be softened to give one a more youthful and pleasant appearance. When droopiness of the brow and excess upper eyelid skin progresses, surgical solutions offer the best results. Typically, a browlift in conjunction with surgery to remove the excess skin from the upper eyelids, is an excellent combination that can be done together. It is important that if a droopy brow and excess upper eyelid skin do co-exist in a given patient, the surgeon needs to be aware and address both of these issues, because if the excess upper eyelid skin is removed without improving the brow, removal of the eyelid skin can actually pull the brow even further down towards the eyes.

The short answer to this question is no. If you think about it for a minute – the distance from the eyebrow to the hairline is constant. What changes is that this tissue all moves downward to crowd the visual field or lower part of the forehead. When this is moved up, the distance really is unchanged; however, the patient looks much more refreshed. On rare occasions we will have a patient who has an extremely high forehead. In this type of patient, we will use a more open approach and we can actually shorten the forehead using this approach. With the endoscopic approach the incisions are placed behind the hairline, but when we have to reduce we only need to perform a forehead reduction the incision is placed at the junction of the hairline and the non-hair-bearing part of the forehead.

The answer to your question is that the browlift performed in your particular case would be essentially what we refer to as a pre-trachiol or trichophytic browlift.  Essentially rather than placing the incision behind the hairline which would move the hairline back further and increase the height of the brow, we make the incision at the junction of the forehead and hairline. In essence this would shorten the forehead a little bit (the distance from the eyebrow to the hairline) by only moving the forehead up and only eliminating the skin at the highest aspect of the brow.  This may be difficult to understand, however, we have a lot of flexibility as to placement and much of the decision as to where to place the incision depends on the individual’s concerns and willingness to tolerate an incision.  The incision in this particular situation is very well hidden and acceptable to most individuals with a high hairline.

The best way to determine which procedure would be right for you is to seek a consultation with a physician who has a lot of experience with brow lifting procedures.  With a practice that focuses only on facial plastic surgery, we have approximately 20 years of experience with the various different techniques available for brow-lifting.  Your information is rather correct – for an individual with a very high forehead, it may not necessarily be ideal to employ the endoscopic browlift procedure as one can move the hairline back a little bit.  This really only applies to a very small patient population with a very high forehead.  Typically it is a much older patient between 65-75 as the amount the endoscopic procedure moves the forehead and the hairline is rather slight.  For that reason in well over 90% of our patients the endoscopic browlift is used to address the brow and mid-face.  Incorporating this technique we use five small incisions approximately one inch in length behind the hairline. This allows complete repositioning of the soft tissue using this minimally invasive technique.