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Drooping eyebrows/ foreheads (brow ptosis) and brow lifting


Brow Ptosis- What is it?
Changes in position and shape of the eyebrow are an integral part of facial expression and influence the way in which one's mood and personality are interpreted by others. Although, there are a variety of eyebrow shapes, on average the female brow has a higher arch than the flatter male counterpart. With age, the eyebrow starts to descend and become less prominent due to atrophy of the surrounding supporting tendons and deflation of the tissue through loss of fat of the scalp, forehead and temples. The eyebrow also starts to alter shape and become less stable. A commonly seen feature is descent of the outer tail of the eyebrow with loss of the gently flared shape of youth to become 'comma' shaped. This is commonly referred to as 'clipping' of the eyebrow.

What causes brow ptosis?
  • Normal Ageing: Most patients do not notice nor complain of actual descent of the eyebrow at all but increased upper eyelid bags or hooding (dermatochalasis) due to increased redundancy of skin in the upper lid fold. For patients wishing to look younger, corrective eyelid surgery (blepharoplasty) will help a lot of these patients but a significant proportion of patients will also require surgery to stabilise or lift the eyebrow. since eyelid surgery alone may actually worsen the pull down further an already drooping eyebrow.
  • Certain illnesses: In addition to normal ageing of the surrounding supporting structures of the eyebrow causing brow ptosis, some disease conditions can cause descent of the eyebrow e.g. facial nerve damage

This lady has involutional changes due to ageing. The outer tail of the eyebrow is descended. Weakness in the middle layers of the eyelid lead to bulging forwards of the fat pockets of the eyelid. Loss of fat at the junction of the lower eyelid and cheek leads to hollowness, the so called 'tear trough deformity'
The typical involutional changes around the eyelid include drooping of the outer tail of the eyebrow.
This lady also has excess upper eyelid skin (hooding) and lower eyelid orbital fat prolapse (eyelid bags)







Problems

Cosmetic: Patients complain that they look tired, stern and melancholic
Headaches: from fatigue of the forehead muscles as patients try to constantly work to lift up their drooping eyebrows
Visual Field problems: sometimes eyebrow descent results in marked redundancy of the below eyelid skin and vision obscuration

Treatment Options
Depending on the patient's complaints and brow ptosis severity, various procedures may be performed to improve the stability and position of the eyebrow. For the small proportion of patients whose symptoms and signs are very severe, these procedures may be offered for functional reasons and would therefore be available on the NHS and through private medical insurance. However, for most patients who seek treatment for brow descent purely for cosmetic reasons, treatment falls into the realms of cosmetic surgery and is therefore only available privately via self funding.

There are several treatment methods that Mr Cheung offers for the treatment of brow descent/instability, all with a different role to play.
These range from:
  • Simple, non surgical methods e.g. muscle relaxing injections into the tail of the eyebrow using botulinum toxin (Botox®) or injection of dermal fillers into the eyebrow to alter brow shape/position
  • Minimally invasive techniques often used in conjunction with eyelid surgery e.g. transblepharoplasty brow lifting, internal browpexy, orbicularis depressor excision
  • Endoscopic and non endoscopic forehead lifting
  • Excisional techniques e.g. direct brow lifting, direct forehead lifting, pretrichial brow lifting, coronal forehead and eyebrow lifting
These procedures vary in complexity. postoperative rcovery time, procedure duration and permanence. Mr Cheung will be able to counsel you on what is most suitable for you based on what you want to achieve and your personal circumstances.

Costs
Brow lifts performed for functional reasons are often available on the NHS or under private medical insurance.
Brow lifts performed for cosmetic rejuvenation reasons range in price from £250 to £2500 depending on procedural complexity.

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