Brow ptosis is a condition that occurs when one or both eyebrows droop. A droopy eyebrow can cause hooding of eyelid skin, which may affect the peripheral vision. Also, a low eyebrow can communicate a tired or angry expression. Lastly, a brow may be raised to achieve better facial symmetry. The most common cause of brow ptosis is aging, although other causes include prior trauma/surgery (including Botox injections) and damage to the facial nerver responsible for elevating the brows.
There are several ways to lift a droopy eyebrow and this surgery may be combined with other procedures, such as a facelift or eyelid surgery.
1) Indirect brow pexy. An indirect brow pexy is usually combined with an upper eyelid blepharoplasty to remove excess skin. In this surgery, the same incision made to remove the excess tissue of the upper eyelid is used to tunnel under the brow and, using one or several sutures, fixate the brow in a higher position.
2) Direct brow lift. In a direct brow lift surgery, an incision is made just above the eyebrow hairs and again sutures are used to fixate the brow in a higher position. A direct brow lift provides a powerful lift, but does leave a scar above the eyebrow hairs.
3) Mid forehead lift. In a mid forehead lift surgery, an incision is made across the forehead in a deep wrinkle. A mid forehead lift elevates the brows and shortens the forehead. This is a good option for patients who have deep forehead wrinkles that can conceal the scar.
4) Pretrichial brow lift. A pretrichial brow lift also elevates the brows and shortens a patient's forehead by making a zig-zag incision just in front of the hair line. This is a good option for patients with a tall forehead whose hair covers the forehead.
5) Posttrichial of Cornornal lift. A posttrichial or coronal lift uses an incision behind the hair line. Through this incision one or both brows may be elevated using sutures or screws. This option provides a more subtle lift and the scar is usually hidden well behind the hair line.
6) Endoscopic forehead lift. An endoscopic forehead lift requires several incisions behind the hair line, through which tunnels are created to release and elevate the brows again using sutures or screws for fixation. Similar to a posttrichial or coronal approach, an endoscopic froehead procedure will provide a subtle lift or contouring of the brows through small incision behind the hair line.
A droopy eyebrow can act like a curtain that blocks the view. Patients with eyebrow ptosis frequently notice that they have less peripheral or side vision, particularly when looking up. The lower the brow position typically the greater the peripheral vision loss. When the eyebrow and/or eyelid is raised, either manually by hand or surgically through one of the approaches described above, the blockage is removed and the eye can see. Brow lift surgery only corrects vision loss due to droopy eyebrows. It does not improve blurred vision caused by problems inside the eye, or by visual loss caused by neurological disease behind the eye.
Patients with eyebrow ptosis report that droopy eyebrows make them look and feel “tired.” When the eyebrow is raised in ptosis surgery, patients usually prefer the new eyebrow position, and feel it improves their appearance as well as their peripheral vision. If the position and shape of the eyebrows do not match, additional surgery may be needed.