Ideal anatomy and proportions:
The structure and position of the eyebrow is a major factor in the aesthetics of a face; a low eyebrow (ptosis of the eyebrow) can appear heavy and close the eyes, giving a tired or even angry appearance. In women, the eyebrow should be located 1 cm above the orbital bone margin (brow bone) and 5-6 cm from the hairline, while in men it should be located on the brow bone to give a masculine look. The top of the eyebrow should be located at the junction 2/3 internal – 2/3 external of the eyebrow, at the height of the lateral limb. The ideal distance between the eyebrow and the upper eyelid fold is 1.6 cm and the ideal distance between the eyebrow and the center of the pupil is 2.5 cm.
We can correct the ptosis (=descent) of the eyebrow by botox, tensor threads or surgically.
Technique :
Botox®:
The top and tail of the eyebrow can be elevated by 1-3 mm by injecting botox into the lateral orbicularis muscle (main lateral eyebrow depressor).
Tensor threads:
Regarding the technique with tensor threads, these are made of PDO (=polydioxanone) and have teeth that hook the superficial subcutaneous tissue and thus apply a traction force. They are inserted through micro-incisions (0.5 mm), run in tunnels under the skin to the scalp and the tension is adjusted to raise the eyebrow. The procedure is performed under local anesthesia, the principle is to make a long tunnel so that the wire has a wide grip and holds longer and to anesthetize the entire path of the tunnel for maximum comfort of the patient, the procedure thus takes 45 to 60 minutes.
Surgery:
This involves releasing the structures holding the eyebrow down (ligaments, corrugator muscles), pulling the eyebrow with non-absorbable sutures, either through the same scar as a blepharoplasty, or through a scar along the upper edge of the eyebrow (direct browlift), or through a 3 cm scar hidden in the hair above the temple, and thus securely attaching this suture to bone.
Results:
Time frame for final results :
Concerning Botox®: there is no social eviction, the results are visible between 4 and 10 days.
Concerning the tensor threads: after a social eviction of 48 hours, one can see immediately the result with a hypercorrection of 2-3 mm then to see the definitive result it is necessary to wait approximately 1 week.
Concerning the surgery: After a social eviction of 7 -10 days, one can see immediately the result with a hypercorrection of 2-3 mm then to see the definitive result it is necessary to wait 2-4 weeks approximately.
Longevity of results :
Botox® : 3-9 months
Tensor threads: 3 – 15 months
Surgery: 5-10 years
Before surgery:
Stop smoking 1 month before surgery
Do not take Aspirin 10 days before surgery, inform Dr. Lucas of any anticoagulant medication (Sintrom, Coumadin, Eliquis, etc..) to arrange for its discontinuation or replacement.
Take Arnica capsules 5 times a day for 5 days before surgery to prevent hematoma.
Contraindication Botox® : myasthenia and neuromuscular diseases, pregnancy, breast feeding
Intervention:
Pain: the pain during the intervention will be almost non-existent, with an adapted anesthesia
Duration of the procedure: 10 minutes for Botox®, 45 minutes for tensor threads, 60 to 90 minutes for the surgery
Anesthesia: local for the threads, local with sedation for the surgery
Location: office for Botox® and tensor threads, operating room for surgery
Outpatient (without hospitalization)
After surgery:
Post-operative pain: 1/10 often responding to Dafalgan
Social eviction :
Botox®: no
Tensor threads: 24-48h
Surgery: hematoma, marked swelling for 7 to 10 days, hypercorrection for 2 to 4 weeks, especially marked for 7 to 10 days.
Suture removal: 7 days for the surgery
Resuming work: ideally 7 to 10 days of rest for the surgery, 1 – 2 days for the tensor sutures, immediately for the Botox®.
Resumption of sports: 2 days for Botox®, 10 days after for the threads, 2-3 weeks for the surgery
Instructions for the surgery and the tensor threads:
Bed rest without major effort (which can cause the opening of small vessels during effort and lead to a hematoma) for 48 hours
Ice mask for 1 week, as often as possible, to reduce swelling
Take Arnica capsules 5 times a day for 5 days after surgery to prevent hematoma
Tensor threads:
Preventive antibiotic Augmentin 1 g twice a day for 3 days after the operation
Disinfection with spray twice a day for 3 days at the thread entry point
Control Dr Lucas D7, 3 weeks, 3 months
Surgery :
Control Dr Lucas D2, D5, D8, 3 weeks, 3 months, 1 year
Vitamin A and artificial tears in the eye for 10 days
Scar massage 2 times 5 minutes per day for 3 months with Gorgonium
Do not press on the lateral corner of the eye for 3 weeks
Instructions for Botox® :
No hot shower, sauna and steam room for 48 hours, do not stimulate the injection points for 48 hours
Complications
Botox® :
– Asymmetry, under-correction
– Diffusion into adjacent muscles: diplopia, eyelid ptosis
Tensor threads and surgery :
-Secondary displacement of the thread: if the thread is stimulated too strongly during the 7 days following the procedure, it may come off. This happens most often with absorbable threads, but can also happen with a thread placed during surgery.
Nerve or vessel damage: the major risk is to damage the temporal branch of the facial nerve, which controls the elevation of the eyebrows, during the placement of threads or surgery. The placement of tensor threads in the context of a “Cat Eyes” must be performed by a doctor who is familiar with the anatomy, with which the risk of nerve damage is almost non-existent.
-Hematoma: there can be bruises, which generally disappear within 4 to 5 days maximum.
-Asymmetry: the canthal balance is precise, symmetrizing it is the work of a goldsmith, discreet asymmetries are often already present before the operation without the patient realizing it.
– Change of the look: it is important to be aware that the canthal balance is a key element of the look and of the overall expression of the face. If it is too strongly positive, it may change your face abruptly and you may have difficulty getting used to it. You should therefore aim for a discreetly positive canthal tilt and not a significantly positive one.
– Discreet folds of the skin: this sometimes happens when the eyebrow has to be significantly raised or when there is a lack of flexibility in the tissues. These folds will disappear in 7 days on average.
– Infection: often treated with antibiotics and local care. Exceptionally, the sutures must be removed when the infection is not controlled despite the preceding measures.
Alternatives and operations that can be combined:
Global rejuvenation of the eye: this operation can be combined with blepharoplasty or a filling of the temples which are sometimes hollowed out
The eyebrow lift can also be combined with a filling of the forehead with hyaluronic acid or fat in order to obtain a round forehead and to mask the relief of the superciliary arches in women.
