There are countless features of the face that contribute to aging that many people never even consider, like the eyebrows. During youth, the lateral brow sits above the upper orbital bony rim and is slightly higher than the inner brow, and the vector of the tail of the eyebrow is more horizontal. This slight arch results in an open, bright look around the eyes and a fresh, vibrant gaze we all associate with youth.
To understand the process of eyebrow aging, it is important to look at photographs from younger years and use them as a guide. The eyebrow tends to descend with age, but not the entire eyebrow. The lateral (outer or tail) brow begins to descend during the 40s and 50s in most individuals, while the inner brow remains essentially in the same position.
Recognizing this specific pattern is the impetus behind the lateral brow lift procedure, which is designed to position the brow back in its original place, avoiding the creation of a “new look” or “surprised” expression that results from the unnatural elevation of the inner and central brow region.
The reason for the drooping lateral brow is simple: the outer brow is not attached to any muscles directly, only the superficial temporal fascia, which is attached to the SMAS (superficial musculoaponeurotic system) that connects with the lower face and neck. As the SMAS descends downward, it pulls the lateral brow with it.
It’s also important to note that the lateral brow sits over the temporal fat pad and the brow fat pad, and as these structures lose volume, the lateral brow segment moves inferiorly.
The inner brow, on the other hand, does not move with age because of its attachment to the muscles and bone. The combination of these changes (descent of the lateral brow with fixation of the inner brow) results in a C–shaped brow that is consistent with an aged appearance.
The net effects of these changes are heaviness and hooding along the outer eyelid region and crowding of the upper eyelid. This is that telltale, haggard droop of the eyes that masks those twinkling windows to the soul.
Placing your fingers along the temple and lifting upward will illustrate the degree of laxity and replicate the effect of a vertical and direct lift at this level. The laxity and heaviness make the eyes look tired and less “fresh,” but simply lifting the outer tail of the brow minimizes those effects instantly in a natural-looking way.
In contrast, when elevating the inner and central brow, the expression looks different and surprised, as well as less natural and attractive.
Examining the faces of women in their 20s and 30s can help guide which segment of brow merits lifting. Several published population-based studies confirm that the most attractive and pleasing configuration is a low inner brow that ascends slightly toward the lateral brow.
This is a new and relatively underutilized method of brow rejuvenation, and it is Dr. Karam’s preferred technique, as it addresses the changes that occur with aging without changing the individual’s look and identity (a major concern expressed by patients when considering eyebrow lifting procedures).
In cases where there is hooding along the outside aspect of the eyes, a lateral brow lift is performed to lift the outer aspect of the brow and elevate the hooding and heaviness that crowds the outer upper eyelid. The incision is made along the temporal hairline and the skin is lifted off the superficial temporal fascia.
A lateral brow lift could be your best option if you’re looking to:
Advantages of the lateral brow lift
The lateral brow lift is commonly performed with the short incision vertical facelift and the upper blepharoplasty. It is also paired with fat transfer and lower eyelid procedures as part of the comprehensive eye rejuvenation program.
As mentioned above, due to the connection between the superficial temporal fascia and the SMAS, the outer brow and the lower face tend to descend together. During the vertical elevation of our facelift technique, the temple and lateral brow will get bunched if not lifted and re-draped together.
As a result, a very common combination is the short incision vertical facelift with extended neck lift and lateral brow lift. This combination allows all of the soft tissue to be lifted together, resulting in a natural restoration.
Excess upper eyelid skin is concurrently involved in nearly all cases in which the lateral brow begins to descend. The combination of the two causes crowding and heaviness around the inner, middle and outer upper eyelid area.
This hooding cannot be treated with the lateral brow lift alone, but requires an upper eyelid blepharoplasty to remove the excess eyelid skin. This is a common combination when both aging changes are happening simultaneously.
Fat transfer hollowing and volume loss around the temple, upper orbital rim and around the eyes and cheeks are often simultaneously treated with fat transfer to restore the fat loss and create a truly rejuvenated appearance that hearkens back to the fullness of youth.
Perhaps one of the biggest advantages from a safety standpoint is that these procedures can be performed under local anesthesia with IV sedation. With this technique, patients are comfortable, moderately sedated and without any pain.
Most patients choose this method to avoid any of the risks associated with general anesthesia. For those patients who do prefer general anesthesia, our facility is fully-equipped for general anesthesia.
Procedures are performed in our accredited and certified (JCAHO and Medicare) surgical center, Carmel Valley Surgical Center, located within the suite. The center offers the highest level of safety and state regulations for outpatient surgery.
Highly-trained and experienced surgical techs, medical assistants, nurses and a board certified anesthesiologist all work together to create the safest and most comfortable experience possible.
Carmel Valley Surgical Center hosts two state-of-the-art surgical suites and a recovery center. The rooms are equipped with only the best equipment and instruments, and the center also has a separate entrance and exit from the main office, which allows our patients to undergo procedures in privacy. Your comfort is always our priority during these surgical procedures.
Following surgery, ointment is applied to the incisions, and a gauze dressing is applied and wrapped around the head. Patients return to the comfort of their home or hotel room, then come back for an in-office check the following day where the dressings are removed and the face is examined.
Antibiotic ointment is used on the incisions for one week. At one week, sutures are removed in the office. At this point, swelling is starting to resolve rapidly. Follow-up appointments are made at one month, three months, six months and one year to monitor healing and make sure all questions are answered.
Recovery is primarily related to swelling. Bruising is not commonly seen in our patients, although it is a possibility. The typical recovery takes between 10 and 14 days. We recommend planning two weeks off of work or social engagements to allow sufficient time to heal.
Although healing is not completely finished by two weeks, most patients are sufficiently healed and can return to work and other occasions. Minor swelling continues to improve steadily for up to one year following the procedure. Exercise is resumed between three to four weeks following surgery, depending on the nature of the activity and the degree of swelling involved.
There are a variety of positive results you can expect from your lateral brow lift, including:
An average board certified plastic surgeon preforms approximately 20 eyelid and brow procedures annually. Dr. Karam, on the other hand, preforms over 350 every year.
Extensive experience translates to more natural results, more consistency and less variability, plus a distinct knowledge of different ethnicities and facial types and how to change the techniques to best suit the particular facial structure. Dr. Karam’s careful and intentional approach ensures that no one changes their identity, but rather simply looks refreshed and youthful.
Dr. Karam’s comprehensive technique, which involves combining these procedures with others, results in synergistic effects. The entire face looks naturally and vibrantly youthful, rather than hosting a single, unnatural element.
In his textbook, Rejuvenation of the Aging Face, Dr. Karam describes his approach to facial rejuvenation and eye rejuvenation in order to teach the ingenious technique to other surgeons and colleagues.
Dr. Karam’s expertise in the subject has also prompted him to write a number of book chapters and scientific articles on facial plastic surgery topics, including lateral brow lifts, upper and lower eyelid blepharoplasty, fat transfer and rejuvenation of ethnic-specific (for example, Asian) groups.
And perhaps most importantly, Dr. Karam’s caring demeanor, excellent patient communication skills and responsive and knowledgeable staff ensure you’re always comfortable and informed. It’s these particular attributes that have earned Dr. Karam the trust to perform these procedures on his medical colleagues and their families.
During the consultation, your expectations will be discussed and a personalized treatment plan will be proposed after careful examination and discussion of your goals. The basic criteria for the timing of this procedure is dependent on two factors: first, whether there is enough sagging to justify the procedure, and second, the patient’s readiness to move forward.
The average patient defines the changes seen in their 40s as a point where comprehensive eye rejuvenation, including a lateral brow lift, would make a positive difference.
In general, the earlier the better. The advantages of performing the surgery sooner are that the changes are less dramatic and the results last longer. More and more patients are utilizing these procedures as a way to maintain their appearance and prevent aging.
Dr. Karam, who is board certified by the American Board of Facial Plastic and Reconstructive Surgery and American Board of Otolaryngology, offers services in San Diego County including San Diego, Del Mar, Carlsbad, Carmel Valley, Encinitas, Rancho Bernardo and La Jolla in Southern California.
If you are ready to schedule an appointment with Dr. Karam, contact us today.(858) 259-3223 Contact Us