How do the forehead and brows age?
Aging of the forehead and brows can be very variable and not entirely predictable:
The brows may always have been low: in men, especially, low brows do not necessarily look unacceptable. Many a movie star has made a living with the use of their low brows!
One is always surprised at how unpredictable aging can be. Here, in the space of five years, we see dramatic changes in the brows (they are higher!) and the lower eyelids, cheek and lower face. However, the eyelid position is remarkably stable!
This series illustrates the aging over 30 years and on the extreme right the results of properly performed brow, eyelid and cheek surgery. No facelift or necklift was performed: we used our "Hammock Lift" principles to achieve overall improvement in the structures of the face: indeed, she now looks as good, if not better than her appearance 30 years previously!
Analysis of the forehead and Brows
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At first glance, the cornucopia of changes on the forehead and brows may seem confusing. Certainly, failure to analyze the changes, forces and anatomy can lead to a “machine gun fire” approach to rejuvenation of the forehead and the brows. Plastic surgery needs to be much more nuanced. |
Identification of the Different Changes
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"Browlifts and foreheadplasty by Dr. BCK Patel MD: I was born with low brows! I always looked mean or angry. However, I was afraid to do anything about it as I kept on seeing photos of people with their brows looking too high. I was finally sent to see Dr. Patel by Dr. Mifflin (thank you, Dr. Mifflin) as Dr. Mifflin told me "he is the best plastic surgeon I know!". Dr. Patel had done a beautiful job. I work in the media and people no longer ask me if I am angry or mad at something. I get botox from time to time to keep my very strong frown muscles under control. Thank you Dr. Patel for a beautiful job. And thank you for lasering my forehead wrinkles and lines away at the same time! I didn't expect that: it was a great bonus." Jenny T 42 Yrs Old with Droopy brows no more - Salt Lake City, UT
Changes superimposed upon underlying anatomy
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There is a complex mix of arteries, nerves, muscles and tendons which contribute to the overlying changes! This applied anatomy must be considered when using toxins, fillers or surgery. Failure to understand this will lead to incongruous results, overly operated brows, or asymmetry. |
Muscle forces at play
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As if the anatomical changes and related anatomical changes are not enough, there are muscle forces at play with:
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The constant use of the frontalis muscle results, in most people, horizontal forehead lines.
Superimposed upon this, of course, may be the changes due to the vagaries of life: brown spots, broken blood vessels, other more minor wrinkles and a roughness of the skin that develops with age. The firm forehead skin of youth is replaced with the stiff but wrinkles and lax forehead skin. The frontal hairline may recede or thin out. The brows generally tend to descend, resulting in further overuse of the frontalis muscles, with further worsening of the horizontal forehead lines. What is termed “frown lines” is the change caused by overaction of the corrugator and procerus muscles, resulting in vertical and horizontal lines between the brows, respectively. Because the support for the tail of the brow is poor, the brow tail tends to descend more than the rest of the brow, resulting in secondary fullness of the lateral upper eyelids and also a “sad” look.
Superimposed upon this, of course, may be the changes due to the vagaries of life: brown spots, broken blood vessels, other more minor wrinkles and a roughness of the skin that develops with age. The firm forehead skin of youth is replaced with the stiff but wrinkles and lax forehead skin. The frontal hairline may recede or thin out. The brows generally tend to descend, resulting in further overuse of the frontalis muscles, with further worsening of the horizontal forehead lines. What is termed “frown lines” is the change caused by overaction of the corrugator and procerus muscles, resulting in vertical and horizontal lines between the brows, respectively. Because the support for the tail of the brow is poor, the brow tail tends to descend more than the rest of the brow, resulting in secondary fullness of the lateral upper eyelids and also a “sad” look.
Loss of fat in brows and upper eyelids: contrary to popular belief, upper eyelids don't always accumulate fat and become fuller. As seen in these photographs taken 50 years apart, we often get loss or recession of upper eyelid fat AND loss of the brow fat pad. Therefore assessment of these structures need to be accurate so as not to age the eyelids further. We often "refill" upper eyelids to give them a more youthful look and almost always augment brows with fat to recreate the fullness of days gone by...
"I had a excellent eye lift done by Dr. Patel. He knows what he is doing and is very pleasant. Dr.Patel was easy to get an appointment and he works with you. The office staff was very pleasant and made you feel calm." D. Gull Highly recommended for eye lift surgery - Salt Lake City, UT
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Forehead
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Dr. BCK Patel MD, FRCS 65 Mario Capecchi Drive Salt Lake City, Utah, US (801) 585-6641 Dr. BCK Patel MD, FRCS 617 E Riverside Dr Suite 101 Saint George, UT 84790 (435) 215-0014 |
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