Many people already know that brow lift surgery can elevate the sagging brow, leading to a more youthful appearance. However, not everyone knows that it can inadvertently alleviate migraine, improve perceived personality traits, and reduce the hooded appearance of the upper lid.
Leading Orange County plastic surgery expert Dr. Tarick Smiley has explained the lesser-known brow lift benefits.
before and after photos depicting great results from brow lift surgery
- Alleviate or even eliminate migraines
Surgeons say that some patients who have had brow lift, also referred to as forehead lift, reported less frequent migraine attacks or even complete remission. Experts have concluded that elevating the sagging tissue may release the pressure that is “pinching” or “irritating” the nerves responsible for chronic headache and its secondary symptoms such as light and nose sensitivity, blurry vision, and nausea.
Researchers at the New York University have conducted a survey showing that people with high eyebrow, which is medically referred to as high oblique frame or wide brow-lid complex, were perceived to be more honest and trustworthy by others.
Whereas people with furrowed brow, either caused by aging or as an inherited feature, scored lower in the perceived trustworthiness reviews.
Aging causes the brow particularly the lateral or tail end to sag, which can lead to an angry or sad appearance, depending on the degree or angle of droop.
Most patients will only need their brow’s tail end elevated, with no or very little advancement of the inner or medial aspect, to achieve a more refreshed appearance.
A youthful female brow lies slightly above the bony orbital rim of the eye socket, and also comes with a soft lateral arch. But with aging, the soft tissue sags causing the tail end to lose its height, leading to a more horizontally oriented shape of the brow.
Therefore, most brow lifts just require conservative elevation of the tail end to restore the lost arch.
- Reduction of wrinkled skin in the upper eyelid
Occasionally, the drooping brow causes skin wrinkles and “heaviness” along the brow-upper lid complex. Hence, lifting the tail end of the brow could make the eyes appear more alert and more youthful without resorting to a separate procedure in the form of upper eyelid (blepharoplasty).
The effects of facial plastic surgery on perceived youthfulness and attractiveness have already been demonstrated by several studies, which typically included ordinary observers who were asked to rate before-and-after photos. However, youth and beauty are not the only defining elements of the face; assertiveness, agreeableness, trustworthiness, and femininity/masculinity also play a role.
A 2015 study conducted by researchers at Georgetown University has shed light on the issue of perceived personality traits and how these could be altered by facial plastic surgeries such as face lift, brow lift, neck lift and eyelid lift. Rhinoplasty, or nose job in layman’s term, was not included because it has no or very little effect on a person’s neutral expression, they suggested.
To eliminate confounding variables like ethnicity and gender, the researchers presented before-and-after photos of 30 white female patients who have had some type of facial plastic surgery. About 170 respondents answered the survey posted online.
The pre- and post-operative photos of the same patient were not presented in a photographic set to prevent recall bias or direct comparison, the researchers noted in the study.
Patients who have had facelift and lower eyelid surgery scored the highest in the personality trait assessments that included perceived attractiveness, social skills, femininity, and likability.
Interestingly, a separate study has suggested that people with high eyebrows and prominent cheekbones were perceived to be more honest even though there was no evidence that facial features were linked to personality traits.
Individuals with flat or sunken cheeks and furrowed brows, on the other hand, were perceived to be less trustworthy.
Meanwhile, a team of psychologists at the New York University has suggested that it takes 33 milliseconds, or a fraction of a time it takes to blink, for the brain to decide a person’s trustworthiness based on his/her face.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley, who was not part of the study, says the findings did not surprise him, as increasing the oblique frame—the distance between the brow and upper lid crease—during brow lift surgery not just leads to a more youthful countenance, but also results in improved trustworthiness and femininity.
Dr. Smiley says that a sagging brow may lead to a perennially angry or sad appearance, depending on the degree or angle of droop, and so a conservative elevation during brow lift can improve a person’s neutral expression—or even her non-physical personality attributes.
Facelift can also improve the perceived likability and trustworthiness by correcting the sunken cheeks, which is done by elevating the drooping cheek fat pad into the deeper tissue.
However, Dr. Smiley warns that the success of facial surgery relies largely on the surgeon’s qualifications and experience, adding that pulling the skin more than a few millimeters than intended, or using incorrect vector of pull, can lead to unnatural results or “weird expression.”
“Prudent patients should ensure that their plastic surgeons are board certified and have been performing the sought procedure on a regular basis,” he says.
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.
Standard brow lift vs. endoscopic technique
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.
When doctors mention 3D facelift procedure, they typically refer to a more holistic facial rejuvenation method, meaning that loose skin and soft tissue laxity is not the only thing addressed, but also the fat or volume loss.
As a stand-alone procedure, facelift tightens the skin and elevates the deeper structures of the soft tissue, bringing them closer the skeleton. While this mechanism creates a tauter appearance, it does not address facial volume loss; in fact, it may even aggravate the gaunt visage.
The patient has received facelift combined with structural fat grafting. Hence, at one year postop her appearance remains youthful and attractive.
To address the inherent problem of facelift, leading Beverly Hills plastic surgeon Dr. Tarick Smiley often combines it with structural fat grafting. It starts with collecting small amounts of fat from tummy or thigh (or any area that carries excess fat), filtering out any biomaterial aside from fat cells and stem cells, and then injecting them into the soft tissue.
By incorporating structural fat grafting, doctors are able to create a more youthful dimension—i.e., there is adequate plumpness commonly found in young faces—which is the main advantage of 3D facelift procedure over the standard approach.
3D facelift procedure also prevents the classic signs of facelift, which include abrupt lid-cheek transition and flatness of the cheeks. Moreover, this new approach can smooth out deep laugh lines and hide the pre-jowl sulcus, which is the dip on each side of the chin.
Furthermore, fat grafting has been tied to improvement in skin texture, one of the auspicious benefits of using fats that are naturally infused with stem cells, which are known for their rejuvenating effects; they have also been found to increase the survival rate of grafts.
Any amount that survives after 2-3 months is expected to be near permanent or at least 12-15 years, as suggested by Dr. Smiley.
In addition to structural fat grafting, facelift may also be combined with other procedures such as neck lift, brow/forehead lift, eyelid surgery, and chin implant. The idea is to create a more congruent result that is less susceptible to gravity and aging.
Breast implant removal with smaller replacement can pose some challenges such as risk of sagging appearance and poor breast contour, although with close attention to details great results can be achieved.
Recently, leading Los Angeles plastic surgeon Dr. Tarick Smiley has performed a surgery on a woman with 500 cc silicone implants who wanted them replaced with 270 cc, which could slash her breast size by almost half.
The patient asked for breast implant removal immediately followed by replacement. But since the new implants were significantly smaller than the old ones, a simultaneous breast lift was performed to maintain natural breast contour.
Due to the significant downsize, she was deemed as a good candidate for a simultaneous breast lift. Without this procedure, her implants would settle too low, resulting in a drooping appearance and deflated-looking upper breast pole.
To remove the old implants along with their scar capsule, Dr. Smiley created a small incision within the breast crease (submammary fold), which would result in a well-concealed scar. He then replaced them with a new pair of smaller implants.
Next, he performed a standard breast lift in which the incision pattern ran around the areola, which was extended downward towards the crease and then across the base of the breast. This would result in an inverted T or anchor-shaped scar that is expected to blend into the background 1-2 years postop.
For long-lasting effects, breast lift should not just be about skin tightening and resection. After all, its elasticity makes it susceptible to the effects of gravity and aging. Hence, the celebrity plastic surgeon creates a more resilient support by remodeling the deeper tissue.
The use of “deep tissue work,” according to Dr. Smiley, also allows the surgeons to elevate some of the tissue of the lower breast pole, resulting in additional upper pole fullness. According to studies, the most preferred breast shape has a 45:55 upper to lower pole ratio (resembling a teardrop shape).
To further promote youthful and natural-looking results, the new position of the nipples should be horizontally and vertically aligned with each other.
Furthermore, tightening the deeper tissue allows the skin to receive no or very minimal tension, which is the key to good healing and “nice looking scars,” says Dr. Smiley.
Breast augmentation transaxillary refers to the creation of a hidden incision at the deepest skin fold of the armpit, thus allowing the surgeons to propel implants into the breast pocket.
Celebrity Beverly Hills plastic surgeon Dr. Tarick Smiley says breast augmentation transaxillary is one of his favorite incision techniques, along with the peri-areolar method (or “through the nipple”), due to the well-concealed scar.
The breast augmentation transaxillary incision technique results in a well-hidden scar.
Aside from the well-concealed scars, Dr. Smiley says the incision technique offers other advantages such as perceived lower risk of infection, implant contamination, nipple numbness, and breastfeeding difficulty.
The benefits of this technique stem from the fact that the implants will not pass through the milk ducts, which are known to harbor staph bacteria.
But as with any breast augmentation technique, Dr. Smiley says the ideal candidate candidate should have aesthetic goals and breast anatomy that are in line with what the transaxillary incision can accomplish.
- Women whose breasts are relatively symmetric and perky.
Since there is no direct incision on the breast, there is no way that the surgeon can elevate or transpose the sagging breast tissue. Hence, the technique is only reserved for women whose pre-existing bosom has a relatively good shape and projection.
Meanwhile, patients with sagging or pendulous breasts and those with deformity (e.g., tubular or torpedo breasts) are not good candidates for the “through the armpit” technique.
- Patients who asking for moderate-sized silicone implants or saline implants of any size (provided they are within the breast/chest dimension).
It is important to note that silicone implants are always prefilled, while saline implants are propelled into the breast pocket empty (they are rolled up like a cigar) before they are inflated with sterile saltwater.
Hence, extra large silicone implants (or 600 cc and higher) require longer incision than that of saline implants, which of course makes it difficult or even impossible to hide the scar within the armpit.
Nonetheless, most patients today prefer silicone implants due to their softer, more natural results than saline implants. For this reason, Dr. Smiley typically uses Keller Funnel during surgery to ensure that the scar remains relatively short and well concealed within the armpit.
Keller Funnel is a disposable device that closely resembles a piping bag. This is used to propel the silicone implant into its pocket with one squeeze and so the implantation process is quicker and less traumatic to the tissue. Furthermore, doctors are able to use a shorter incision with this technique.
- Patients with a strong history of keloids.
Several studies have suggested that darker skin is susceptible to keloids; hence, ethnic patients tend to choose breast augmentation transaxillary since the incision is placed in this hidden area, which is also known for being highly resistant to aggressive scarring.
Aside from ethnic patients, younger women (i.e., Millenials) often find it unacceptable to have scars on their breast and so they typically inquire about the possibility of placing the incisions within their armpit.