Today we are going to talk about the upper third of the face, which is the forehead, brows and upper eyelids. It is the area that most people first come to discuss when they think that their face is ageing, and in most people represents the “easiest fix”.
The commonest issue with the forehead is horizontal wrinkles and a deep frown line. Sometimes these develop through habit (think having teenage children!) or they may be there due an unconscious reaction to having a droop in the brow. If this is the case, the muscles in the forehead are trying to hold the brow and skin of the upper eyelid away from your visual field.
In either case, injection of botulinum toxin can help to reduce the wrinkles and to a certain degree help in lifting the brow. In terms of reducing a frown, there is not better way than injectable products, even though they require repeating every three months for a good consistent result.
As you get older, or sometimes it’s just a family thing, the position of the eyebrow relative to the bony ridge that forms the eye socket, can drop, giving a heavy, tired appearance. Men naturally have a lower brow, which is why a low brow in women can look unappealing. Injectable products can lift a brow by a few millimetres, but surgery is sometimes a better option. To see if you might be suitable for such a procedure, use your thumb to lift the tail of your eyebrow and see if it looks better. Essentially that’s what I do!
There are two types of brow lifts that I think are effective.
A simple lift involves cutting a crescent of skin from directly above the tail of the eyebrow and shortening the muscle beneath. This leaves a fine scar paralleled with the eyebrow hairs and can be accomplished under local anaesthetic in the rooms. The second type of lift involves an incision parallel with the hairline and involves lifting the whole brow off the skull before shortening the same muscle. It is often better for patients with more severe droop in whom it would be difficult to camouflage a scar. Even after a brow lift, some people require botulinum toxin for a period of time to get out of the habit of elevating their brow with the forehead muscles.
The upper eyelids are usually the first surgical procedure that both men and women request, due to skin flopping down over their visual field, particularly at the side. In women, it isn’t simply a matter of chopping off the spare skin. Behind the muscle of the upper eyelid is a tongue of fat which pushes forward into the lid, and unless this is reduced at the same time the eyelid tends to reassume it’s formed appearance quickly. There is a second blob of fat right in the corner of the eye that requires trimming down in most people.
Surgery on the upper third of the face is usually day case, and recovery is less than two weeks, depending on the extent. On average, we see patients in their mid forties, although if the problem is “a family thing” , it can be much younger. Tomorrow we are going to talk about the middle third – the lower eyelids and cheeks.
Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.