Gravity is a major contributor to the appearance of aging of the face
and neck. A facelift is very effective at lifting the sagging skin of the neck and lower face but does not address the problems in the upper face (at and above eye level). In the upper face (forehead, brows and temples), sagging will lower the brows and deepen “crows feet” wrinkles in the temple area. A lowered brow can contribute to excess skin and drooping of the upper eyelids, resulting in a “heavy” or tired appearance of the upper lids. Excessively low brows may even block part of an individual’s visual field.
Many people compensate for sagging eyebrows by overusing their forehead muscles to lift the eyebrows. The forehead muscles (referred to as the frontalis muscles) lift the brows but also cause horizontal wrinkles in the forehead. The more these muscles are used, the deeper the forehead wrinkles become. Frown muscle action, which pulls the brows closer together, produces vertical frown lines and also pulls the brows down farther, worsening the gravitational sagging of the brows.
In the upper face, muscle activity can be temporarily suppressed with botulinum toxin (Botox, Dysport, Xeomin) injections. Relaxation of the treated muscles will improve frown lines, crows feet wrinkles, and horizontal forehead wrinkles. In the forehead, there is a trade-off between improving forehead wrinkles and additional lowering of the brows. If the forehead muscles are totally paralyzed, the horizontal forehead wrinkles will look very smooth, but unfortunately the eyebrows will sink even lower. This produces a heavy look to the brows and results in even more droopy, excess skin in the upper eyelids.
A brow lift (also called forehead lift) is the single procedure that does the most to improve the aging changes in the upper face. In a brow lift, the outer part of the brows are elevated just a few millimeters, improving the brow position and reducing excess skin of the upper eyelids and in the crows feet area. The outer brow changes from slanting downward to a more horizontal position. This improved brow position gives the area around the eyes a more alert, well-rested appearance. Another great benefit of the brow lift is improved horizontal forehead wrinkles. The higher brow position reduces the need for the patient to use their frontalis muscles, thus improving the forehead wrinkles. Unlike Botox injections, which improve forehead wrinkles but worsen (lower) brow position, the brow lift improves both forehead wrinkles and brow position.
Dr. Langdon uses the advanced endoscopic technique for brow lift. Use of the endoscope requires only small skin incisions just behind the hairline and enables a minimally invasive approach to brow lift with minimal scarring and no hair loss. The traditional method (coronal brow lift) requires a long incision (from ear to ear) behind the hairline, which results in a visible scar with permanent hair loss and possible numbness in the scalp. Dr. Langdon’s method includes inactivating the frown muscles, which in most cases obviates the need for future Botox treatment in this area. Most of Dr. Langdon’s brow lift patients thus enjoy not only improved brow position and reduced forehead wrinkles and frown lines, but they also do not require ongoing Botox injections to these areas.