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WHEN FILLERS no longer do the job filling in deep crevices and returning your face to a youthful-looking, rounded appearance, you may be ready to leap to a longer-term solution. But which one?
In researching My Little Bird’s series on plastic surgery, we’ve consulted some of the area’s top doctors for the lowdown on the types of surgery available, which one works for what problem and how much money each will set you back.
Beginning at the top of the face, we spoke with Dr. Craig Dufresne, a board-certified plastic surgeon who has offices in Chevy Chase, Md., and Fairfax, Va. During the aging process, he explained, brows that begin positioned above the top orbital rim gradually descend. He talked about four different brow-lift procedures that can undo that process.
The coronal lift is the most traditional and extensive; incisions go across the scalp from ear to ear. You work your way down to the edge of the forehead skull into what are called orbits and essentially peel down the scalp and take out some of the muscles responsible for frowning and squinting, and, depending on how extensive you want to be, you can control ultimate facial movement. Recovery takes a couple of weeks. Because of proximity to the eyes, expect swelling, black eyes and bruising. Although this procedure can be performed under sedation, a light general anesthetic works best for most people.
Who’s it for: For someone with deep furrows and brows that come down below the rim, the bony part of the forehead.
Pros and cons: The brow gets lifted up completely; it’s a dramatic improvement and a long-time fix. Because it cuts across several sensory nerves in the forehead, it can result in long-lasting or permanent numbness in the area.
Cost: It’s the most extensive and most expensive, $5,000-$10,000.
For the less-invasive endoscopic lift, two to three incisions between 11/2 and 2 inches long are placed behind the hairline, where scars will be hidden. A fiber-optic instrument is connected to a camera and hooked up to a video monitor to provide a clear view of the muscles. This lift is similar to the coronal because you’re working on muscles that cause frowning, furrowing and wrinkling of the forehead, but small instruments allow you to make small incisions for taking out, tightening or loosening and redrawing the skin. To hold the position of the forehead while healing, there’s an option to use dissolving surgical screws and thread, which disappear over a period of weeks. The procedure may be done under sedation or general anesthesia. Like the coronal, the results are long-lasting.
Who’s it for: Patients with average brow wrinkling and sagging, referred to as brow ptosis.
Pros and cons: Advantages are limited incisions and fewer sensory changes because you can avoid nerves more effectively. There is less numbness and a faster recovery time, and it’s a long-lasting procedure. If skin is pulled too tight along the incision, however, you can strangle the hair follicles and cause an area of baldness.
Cost: $4,000-$6,000. It’s a shorter, less-invasive operation than the coronal lift, cutting down on hospital and anesthesia fees.
For a crescent lift, a half-moon incision is made just above the eyebrow to remove a slight amount of sagging. An advantage of the procedure is that for patients with asymmetrical brows, you can take a bigger slice from one side than the other or perform the procedure on only one side.
Who’s it for: Patients with a limited amount of wrinkling.
Pros and cons: Avoids any sensory problems. The scar follows the shape of the eyebrow. You can use eye makeup to hide it.
Cost: $1,000-$2,000
A thread lift is usually combined with an upper eyelid lift, so once the latter is finished, you can pull up the outside corners of the eyebrow with thread.
Who’s it for: Women who want to get back the appearance of a sweeping eyebrow curve.
Pros and cons: It’s possible to overdo any surgery; the art is not to overcorrect.
Cost: This is usually included in the cost of surgery for an upper eye lift, which runs between $3,000 and $5,000.
–- Janet Kelly