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Steven J. Pearlman, MD, FACS Dual Board Certified in Facial Plastic Surgery

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Forehead Rejuvenation

browliftA browlift restores a youthful fresh appearance to the upper face. Sometimes a drooping or furrowed brow can make you look sad or angry. The forehead can drop with time, causing hooding of the upper eyelids. Eyebrow position is an important part of one’s expression and youthful look. Hooding of the upper eyelids may actually be more a result of a sagging brow rather than excess upper eyelid skin. A forehead or browlift can address these changes.

The ideal eyebrow is club shaped (rounded at the center and tapers towards the sides) and starts next to the nose along a vertical line drawn upward from the corner of the nose. The lateral extent is along a line drawn from the corner of the nose through the corner of the eye. Both ends of the brow should be at the same level. Generally, in women, the head of the brow starts over the bone of the eye socket then arches delicately upward, whereas in men it should be more horizontal. The highest point of the arched brow should be above the corner of the eye. So, when raising a brow, typically the sides should be higher than the center.

Dr. Pearlman often asks patients to look back at photos of themselves from a younger age to see if the position of their eyebrows has truly changed. Patients are encouraged to bring these photos in for the initial or follow-up consultation. If you open a fashion magazine, as with all cosmetic surgery today, you will see that there is no one brow position. It’s more about the shape of the brow that is important, as well as the elimination of hooding. The best brow is one that fits your face and restores youthful beauty and “punctuation” to the face.

Actual Patient of Dr Pearlman

Endoscopic Browlift

A drooping brow can be corrected through 4 or 5 tiny incisions behind the hairline. Endoscopic or minimal-incision browlift utilizes an endoscope, which is a skinny telescope similar to those used by the Orthopedists to look into knees. This technique minimizes loss of sensation and hair at the incision sites. New avenues in cosmetic surgery include lifting sagging cheeks for a mid facelift as an extension of the endoscopic brow and temple lift.

Coronal Browlift

The more traditional technique is a coronal lift, which requires an incision from the top of one ear, remaining behind the hairline to the opposite ear. The entire forehead is elevated through this incision from above. The coronal browlift is infrequently used because of the extensive incision. However for patients with high hairlines, the hairline position can be maintained or even lowered by a browlift using an incision just at the hairline. When performed meticulously this incision is barely detectable. This is called a pre-trichial browlift.

Questions? Contact Dr. Pearlman about browlift or other facial procedures



Answers to frequently asked questions about the procedure

Q: Can Plastic Surgery Help my Eyes Look Less Tired?

Eyelids can look "tired" from a number of reasons. The more common ones are bags under the lower eyelids, excess skin of the upper and/or lower eyelids and drooping of the eyebrows. You don't have any of these.

Your eyelids slant downward towards the sides; the corner where the upper and lower eyelids meet (called the canthus) is lower towards your ears than near your nose. There are a number of surgical techniques that can be used to raise the lateral canthus. Sometimes, there may be some hollowness of the bone of the eye socket as well. This is also treatable. Seek out a surgeon who is versed in this procedure for a more definitive discussion.

Q: How long does a rhinoplasty last and at what point will you need to do additional maintenance?

A: A rhinoplasty will last for the rest of your life. However, even a nose that has undergone a rhinoplasty ages like the rest of your face and body. As we age, the nose begins to droop. After a rhinoplasty they will age from where they were after the procedure. The procedures we do for an aging nose is often more subtler than a formal rhinoplasty.

Q: What is a "mini lift"?

A mini-facelift of today was the maxi-facelift of 2 decades ago. Mini or maxi, best to discuss with your doctor.  There are many definitions of what a mini-facelift is. For some it's a shorter incision, for other doctors its less work on the muscle called the SMAS. The technique depends more on the doctor's skill and your anatomy. For a patient in their early 40's, you often don't need the same deep plane facelift that someone in their 50's or above might need. Most of these procedures address your jowls.

Q: If I were to have a rhinoplasty and septoplasty, would I go to a facial plastic surgeon, ENT or Plastic surgeon?

A: Performing both a quality septoplasty and rhinoplasty is dependent on the individual's training and experience. Generally, facial plastic surgeons start with ENT training before they move on to facial plastic surgery. Although they are not formally trained, many plastic surgeons can also be experience and qualified to perform septoplasty procedures. The main focal point should be how much training they have received and how much experience do they have performing the procedures together and separately. There are subtle signs that could indicate if the proposed surgeon is right for you:

  • Did the surgeon look inside my nose? (As surprising as it sounds, in a number of my revision consults, patients often say that their original surgeon never looked inside their nose.)
  • Do they have specialized instruments to tackle the procedure? (A special headlight, nasal instruments, etc.)
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