The standard brow lift technique uses an ear-to-ear incision across the top of the head, within the hair-bearing scalp. While it provides the most lifting effect, it comes with one major downside: Patients whose “starting” forehead is big may end up with a “five-head effect.”
People use the humorous term five-head to describe a forehead that is oddly large that five fingers can all fit on the space between the hairline and eyebrow, instead of just four fingers.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that most brow lift patients either want to maintain their forehead height or even slightly reduce it, making the standard technique inadvisable because it can elevate the hairline by up to 1 inch.
A hairline that is too high not just results in the five-head appearance, but it also has a masculinizing effect on the female face. Nonetheless, the standard brow lift remains ideal if the patient has a notably short forehead (which may sometimes lead to a primitive look) and desires to change this feature.
But for most patients, placing the incision precisely at the hairline, instead of inside the scalp, provides the most auspicious results—i.e., it maintains the hairline height or it can be even elevated if the patient wants to shorten her forehead.
The endoscopic technique is another type of brow lift that has no or very little effect on the hairline height; this often involves 4-5 tiny keyhole incisions placed behind the hairline. It favors patients with minimal forehead and brow sag.
With the right incision pattern based on the patient’s desired goals and starting anatomy, brow lift can provide natural looking effects. This is particularly true when the lateral brow or “tail end” is elevated, with no or very little change in the height of its medial or inner aspect.
To ensure that the scar remains hidden, all efforts are made to reduce the tension on the skin especially during the healing stage. Hence, most skilled surgeons use the horizontal and vertical mattress sutures so that the deeper structures carry most of the tension, instead of the skin.