Brow Lift in Dallas, TX

Traditional Open Brow Lift

Brow lifting is not a new procedure and has been part of the surgical method of facial rejuvenation now for decades. In the old days, a full incision across the top of the scalp was the only way to perform this procedure, which is still favored by some surgeons.

This open type of brow lift involves an incision behind the hairline (coronal), on the hairline (trichophytic), or in front of the hairline (pretrichial):

• Coronal incision: Elevates the hairline and may lead to hair loss.
• Trichophytic incision: Maintains the hairline position.
• Pretrichial incision: Lowers the hairline.

In general, Dr. Lam opposes these methods because he does not believe they are necessary and has led in many cases to long-term problems like prolonged and permanent scalp numbness, contour irregularities on the scalp, and permanent hair loss and scarring, which he has had to fix with hair transplant.

Endoscopic Brow Lift

Endoscopic brow lifting became in vogue about 25 years ago as a replacement or advancement over prior open techniques described above. Dr. Lam performed this technique for many years.

This technique involves limited incisions along the hairline, usually 5, where the surgeon can release a band across the brow contour from these access points and thereby release and elevate the brow. Dr. Lam has abandoned this technique due to variable results where the brow can relax back to where it was early after the procedure.

Subcutaneous Brow Lift

Today, when Dr. Lam performs a browlift, he prefers a subcutaneous technique along the temporal fringe of hair. He believes that he achieves more predictable outcomes with less risk and less recovery than even the endoscopic technique, which he used to favor. His technique reflects his philosophy, which is “get as close to the problem as possible to correct it.”

The endoscopic technique requires a deep, wide release of all of the tissues along the brow bone ridge but the problem with this release is not the recovery but the limited results. Because the release of tissue occurs very deeply, the outer brow skin still can sag after a few weeks’ time. By approaching only the outer brow skin sagging very close to the problem without going a far distance, he is able to achieve a more predictable outcome with his browlift results with more limited downtime.

The Role of Fat Grafting

Fat grafting can provide an alternative approach to brow lifting but it can also serve as a complement to a brow lift. In many cases, Dr. Lam can avoid a brow lift using only fat transfer since he believes most individuals would benefit from a fat graft to the brow but more select individuals would need a brow lift. This philosophy goes against a popular idea that brow lifting is more important than fat grafting.

Dr. Lam uses the analogy of the brow deflating like a balloon. When it is deflated, adding volume can re-inflate the area that has lost volume. It is a bit counter-intuitive and difficult to understand because most individuals think the brow is too sagging or “heavy” and the thought of adding more fat does not make immediate sense. Dr. Lam will help you understand the role of blepharoplasty, fat grafting, and brow lifting in your situation.

When Blepharoplasty or Fat Grafting May Be Considered

• Crepey or sagging upper eyelid skin: An upper blepharoplasty may be considered, particularly when excess skin hangs over the eyelid edge.
• Hollowness around the brow: Fat grafting may be beneficial when volume loss makes the upper brow bone or its contours more visible.

When a Brow Lift May Be Considered

• A brow lift may be considered when the outer brow skin hangs or hoods over the outer eyelid, particularly when the hooding extends laterally toward the ear.

Depending on your anatomy and goals, Dr. Lam may recommend blepharoplasty, fat grafting, a brow lift, or a combination of these procedures.

Brow lift, upper blepharoplasty, and fat grafting results are essentially permanent with a few limitations that need to be explained. For brow lifts and upper blepharoplasty, there will naturally be some relaxation of the tissues over the first few weeks to months and after that time whatever remains should be considered permanent. Similarly, with fat grafting, when the blood supply fully kicks in, then whatever fat is retained should continue forever. In general, he says that you should really wait a minimum of 6 months’ time before the result should be considered permanent. Even though there can be still some minimal loss after that time towards a year, most of the result can be quite stable in most but not all cases after 6 months’ time.

The one thing that must be kept in mind, as Dr. Lam says, is that the result is “permanent minus further aging.” In other words, as you get older, you will lose some of the result because of sun damage, stress, diet, and just living on planet Earth. However, that being said, if you have two identical twins, both of whom have the exact same lifestyle, the one who has had the browlift, blepharoplasty, or other cosmetic surgery should always look substantially younger than the one who never had the procedure done even years later.

In general, brow lifting has a relatively short recovery but there can always be unwanted swelling and/or bruising that is unpredictable depending on your anatomy, etc. Also, if Dr. Lam performs other procedures like an upper blepharoplasty (which usually does not add a lot of recovery time) and/or fat grafting (which usually makes the eyelids look more swollen for 1-2 weeks), there can be additive recovery elements.

Dr. Lam and his team will walk you through what the recovery entails. However, because Dr. Lam uses a very gentle hand, a lot of tumescence (fluid injected to minimize bruising) during the procedure, possibly tranexamic acid (an anti-bruise medication given intravenously) in the right candidate (which will be discussed with you whether it would be safe and appropriate for you), and a light conforming, pressure dressing, his patients usually do not undergo significant recovery periods. Also, you should have very little discomfort in most cases after his procedure. In any case, you are welcome to ask Dr. Lam more questions during a consultation. He will also have a separate time where you will meet with his staff who will go over more specific details regarding the procedure (preoperative, operative, and postoperative considerations).

Brow lifting surgery is very safe in Dr. Lam’s hands. The risks include nerve issues (numbness and movement problems), scarring, and hair loss (temporary and permanent). Fortunately, with Dr. Lam’s targeted, limited technique, the worst situation he so far has encountered long term is temporary hair shedding in the area around the incision. Use of his product Folliflo can be a natural method to minimize the risk of temporary hair shedding.

Dr. Lam’s brow lift technique is designed to create a natural-looking elevation of the outer brow while avoiding the overly surprised appearance that can result from more extensive lifting. Rather than traditional methods that may require longer incisions, he performs a subcutaneous brow lift using a small incision along the temporal hairline. Through this incision, Dr. Lam carefully dissects the tissues beneath the skin toward the outer brow, lifts the excess tissue that hoods the outer eye, and closes the incision in multiple layers with dissolvable sutures.

Dr. Lam uses a trichophytic incision, which allows hair to grow through the scar to help make it less noticeable. He also uses highly diluted Botox in the incision area at the end of the procedure to support the healing process.

For many patients, however, Dr. Lam believes a brow lift may not be necessary. Fat grafting can sometimes restore lost volume and convexity around the brow without surgically lifting it. During a consultation, Dr. Lam can discuss whether a brow lift, fat grafting, blepharoplasty, facelift, or a combination of procedures may be appropriate for your goals.

The cost of a brow lift and any recommended complementary procedures will be provided at the time of consultation, including a breakdown of the individual components. For most of Dr. Lam’s patients, surgery is performed at his on-site, Joint Commission-accredited surgery center at the Willow Bend Wellness Center in Plano, Texas, just north of Dallas.