There are various options for treatment of the forehead and brow. The decision regarding the treatment depends on the exact problem. A long forehead can be shortened (coronal brow lift), but a short forehead cannot be lengthened. Eyebrows that are too low can be raised (coronal brow lift, endoscopic lift). Deep wrinkles between the brows can be temporarily paralyzed (neurotoxins) or removed (limited incision muscle resection). Deep horizontal wrinkles can be temporarily paralyzed (neurotoxins) or removed (coronal brow lift). Asymmetric brows can be brought into harmony (direct brow lift).
Coronal brow lifting is often considered the “gold-standard”. It has been performed for many years and gives predictable results, which are long-lasting. Unfortunately, many patients are scared away when I tell them that it requires an incision within the scalp that spans from ear-to-ear. I can honestly say that the scar can be barely visible, but by this time, some patients are already glassy-eyed. For those willing to accept the minor scar, coronal brow lifting is often the best choice.
For those “glassy-eyed” patients who want to run out of the office at the thought of a coronal brow lift, endoscopic forehead lifting may be an option. This utilizes small cameras inserted through the scalp, followed by lifting of the brows. This is a reasonable option if the brow is too low, but it will not change the length of the forehead. Although endoscopic lifts have been shown to provide long term lift of approx 5mm, I prefer to think of it as a method of keeping the brows from sagging any further, rather than long-term lift.
Neurotoxins (Botox, Dysport, Xeomin) have transformed the state of brow and forehead lift. These neurotoxins can be used to temporarily improve wrinkles of the forehead and between the brows. The use of neurotoxins avoids a surgical procedure and can be performed in a short period of time. If more permanent results are desired, limited-incision muscle resection or forehead lifting may still be performed. Neurotoxin use may also elevate the lateral brow, but will not dramatically change the brow position or the length of the forehead.
Overall, there are many options for forehead and brow rejuvenation. The use of neurotoxins has changed the landscape- many are choosing to have an easy, temporary result rather than a surgical, permanent result. Because of the variety of treatments, forehead and brow rejuvenation can result in long-term, natural appearing results.