One of the earliest signs of ageing occurs in the forehead and eyebrow area. Female patients find this most troubling, as they lose the natural elevation the eyebrow assumes as it approaches the temple. This is a direct result of the constant use of the muscles in the forehead for facial expression. Adding to this is the effects of gravity and the loss of skin and muscle tone that occurs with age and repeated exposure to the sun. Forehead wrinkling has been a commonly treated aesthetic ailment with the growing use of BOTOX® and other neuromuscular paralysing agents. One area of particular concern is the wrinkling that occurs over the bridge of the nose between the eyes. This area can not be treated with BOTOX®, and many patients are not satisfied with the chronic use of collagen substitutes, or “fillers,” that need repeated injecting to fill in these creases. Drooping of the eyebrows can also lead to excessive eyebrow skin accumulating in the upper eyelid. It is important to discern excessive eyebrow skin from excessive upper eyelid skin, due to the potential complications that can arise from excising eyebrow skin above the eyes. Some patients develop such severe drooping of the eyebrows that vision is lost due to eyebrow skin accumulating over the eyelashes. Insurance companies reimburse for this severe condition, deeming it medically necessary to restore lost vision.

As surgery has advanced, a movement has been made away from the once popular coronal brow lift. In this procedure, a patient was literally scalped as an incision was placed from ear to ear to elevate the forehead and brow. While accomplishing adequate results, patients often complained of the loss of hair, loss of sensation, and unsightly scar that this procedure produced.