The ideal female brow lies above the bony rim above the eye, has an arch that peaks at the outer part of the cornea (colored part of the eye), the lateral extent lies in a diagonal from the outer part of the nose through the outer corner of the eye, and both the inside and outside extent are at the same level. In the male, the brow lies at the bony rim in a horizontal fashion with less of an arch, is more full, and both the inside and outside extent are at the same level.
With age the brow begins to drop, and the outside corner turns downward. WIth excess ptosis (drooping), the brow can push down on the upper eyelid and even begin to obstruct your vision. It is important to distinguish between the brow and the upper eyelid as the cause for a "tired" eye as the treatment, although complimentary, differs.
There are many approaches to reposition the eyebrow.
The first option is the direct approach. This involves making an incision directly above the eyebrow. This is very rarely chosen but for patients with facial paralysis and one eyebrow drooping, it can be a great option.
The second option is the indirect or mid forehead approach. This involves making two separate incisions in wrinkles present in the forehead. This is only an option for patients with very deep forehead wrinkles that would hide the incisions.
The third option is the pretrichial (just in front of the hairline) incision. The nice part about this incision is that it can help to raise a high hairline at the same time that it raises the brows.
The fourth option is the coronal incision. This involves making an incision within the hairline. This is nice in that it completely hides the incision, but it does raise the hairline which may not always be an option.
The fifth option is the temporal incision. This is useful when just the outer corners of the brows have fallen. This incision is within the hairline but is much smaller than the coronal incision.
The final option is the endoscopic approach. This involves the use of several smaller incisions within the hairline and cameras to raise the brows.
Each approach has pros and cons, and Dr. Guy will recommend the most appropriate one for you based your desires and physical characteristics in the consultation.