Oct. 18, 2000 -- Thinking about botulinum toxin (Botox) injections to get rid of your frown lines, or an upper face lift, known as a "brow lift," to get rid of your furrows? New techniques are on the horizon, according to researchers who presented their findings recently at the annual meeting of the American Society of Plastic Surgeons.
One new procedure for frown lines has more durability than Botox injections, which have to be repeated every few months, reports Richard H. Bensimon, MD, a plastic surgeon who practices in Westport, Conn. "[Botox] injections are very effective at eliminating frown lines, but they have to be repeated," he tells WebMD. "This [newer surgical] technique removes the muscles that cause the frown, and the results are permanent."
People typically lose the ability to frown when they get Botox injections also, because the muscles involved are paralyzed. However, Bensimon says that most patients don't miss their frowns at all, and come back for retreatments at the first sign that the muscles are regaining function. The problem with Botox is the need to retreat.
The procedure for removing the muscles that cause the frown lines is called a "glabellar myectomy" because it removes a portion of the glabellar muscles, which are the muscles that make the frown; a myectomy is the removal of muscle tissue. The surgeon makes a small incision in the eyebrow and removes the muscle tissue through this incision. The remaining scar is inconspicuous because of its location in the eyebrow, says Bensimon.
The new brow lift procedure, called the brow suspension, involves smaller and fewer incisions than the procedures currently practiced. With this technique as an option, the youth-conscious may be able to put off more complete cosmetic surgery procedures, according to Onur Erol, MD, a plastic surgeon practicing in Istanbul, Turkey. Brow suspensions must be repeated every one to six years.
Older or "open" brow lifts were characterized by long, ear-to-ear incisions that left a scar. Some patients also reported a lingering numbness in the area, says Ama Prafad, MD, who provided WebMD with an objective assessment on the new procedures. Open brow lifts are rarely performed now. With a newer technique -- endoscopic brow lift -- smaller incisions are possible because they involve the use of an endoscope, a fiberoptic instrument that allows the surgeon to see inside the area to be operated. Endoscopic procedures do not lift the brow as extensively as the old open procedures, says Prafad, an ophthalmic plastic surgeon practicing in New York City and in Garden City on Long Island.
In contrast to the brow lift, in the newer brow suspension procedure, the surgeon makes two 1 mm incisions within the eyebrow. Two other incisions are placed within the hairline, directly above the eyebrow incisions. The surgeon then places a tube underneath the skin between the eyebrow and hairline incisions and threads a suture through the tube. The eyebrows are thus lifted and held in place. This surgical procedure is less intensive than the endoscopic brow lift.
Brow suspension is more appropriate for young patients who want to slow down a minimal droop in the brow, according to Erol. Rather than being a definitive treatment for a sagging brow, it's a temporary lift that helps forestall a major facelift. As with many cosmetic procedures, the tradeoff is invasiveness vs. results. In other words, the less invasive brow suspension involves fewer and less extensive incisions, but it has less permanent results than the endoscopic brow lift and requires retreatment.
If you want a younger looking brow, what questions should you ask the cosmetic surgeon? "Ask the surgeon what technique he or she would use to lift and mobilize the brow," says Mauro Romita, MD, who provided WebMD with some expert advice on the subjet. "What is his or her opinion of the ideal brow position for a patient?"
Romita, who is an assistant clinical professor of plastic surgery at New York Medical College and an attending plastic surgeon at St. Vincent's Hospital in Manhattan, adds, "The surgeon should analyze a photograph of the patient and pull on the brow with his or her hands to find the natural position. The patient should be part of the decision."