What is a Brow Lift?
Also known as a forehead lift, a brow lift reduces horizontal forehead wrinkles and frown lines on the bridge of the nose, and between the eyebrows. It can also raise the eyebrows and increase the distance between the eyelashes and the eyebrows. As you age, your face skin and soft tissues lose their firmness and gravity pulls them down creating a sad, tired or angry expression on your face. Through a brow lift your surgeon removes excess tissue on the forehead, alters muscles and tightens the forehead skin to place the eyebrows in an alert and youthful position. A brow lift is a more permanent alternative to BOTOX of the forehead and can be combined with other facial procedures, like a face-lift or blepharoplasty (eyelid surgery).
Who is a good candidate?
You are a good candidate for a brow lift if:
- You have droopy eyelids due to your eyebrows shifting down from their natural position
- You have deep frown lines and lines on your forehead
- You have a positive outlook, with a clear and realistic vision of what you want the procedure do for you
- You are otherwise healthy and do not have a serious illness or medical condition that may impair the healing
- You are a non-smoker or can abstain from smoking for at least three weeks before and after the surgery
Due to the prominence of the forehead and eyebrows in one’s appearance, many methods have been devised to tailor brow lift surgery to each individual unique case. Your surgeon may choose to combine a brow lift with other procedures to achieve the best result.
1-The Coronal Lift:
This is the classical approach for brow lifting. In this method, one incision is made from ear to ear across the top of the head. Then your surgeon pulls the skin away from the underlying tissues, loosens the muscles and removes excess fat and skin. The incision is then closed with stitches in different layers. The resulting scar from a coronal lift is well hidden within the hair and can be further concealed with a zig-zag incision. This is a good choice for women with high hair density and normal to short forehead who show an advanced level of brow droop.
2-The Pretrichial (Hairline/Trichophytic) Lift:
This method is recommended for women with very high foreheads and advanced level of brow droop. Your surgeon may choose this method to avoid extending the height of your forehead by placing the zig-zagged incision along your hairline. The resulting scar, while somewhat more visible, can often be hidden with bangs. The rest of the procedure is similar to the coronal lift.
3-The Endoscopic Lift:
If you have mild to moderate brow droop and horizontal wrinkles and/or thin hair or receding hairline, an endoscopic lift may be a good choice for you. Your surgeon will insert an endoscope through 3-5 small 1-2 cm incisions placed just behind the hairline and uses special instruments to alter or re-position the tissue and muscle beneath the skin. Incidences of complications are rare and recovery time is significantly lower in this method.
4-Limited incision or The Temporal or Short Scar Lift:
This is best used for the patients who are concerned about flat eyebrow or sagging of the skin affecting the outer portions of their eyebrow. It is also the method of choice for relatively younger balding men who have little temporal hair remaining. In this technique about 4 cm, long incisions are placed hidden in the temporal hairline on each side. This procedure does not address the center area of the brow and the frown lines. However, it can reduce wrinkles at the corners of the eyes and if combined with an eyelid lift (blepharoplasty) your surgeon can remove the frown lines as well.
5-The Direct Brow Lift:
In this method, an incision is made directly above the eyebrow in a pattern to create the desired lift. Then your surgeon removes forehead skin directly above the eyebrows. Although it has the potential to leave visible scars if done carefully the scar can be concealed with the eyebrow hair. Nevertheless, this method is reserved for candidates with male pattern baldness or a very high hairline and for individuals with one-sided brow ptosis (sagging) and eyebrow asymmetry.
Depending on the method used for the procedure and whether it is combined with other procedures a brow lift can take one to two hours under general anesthesia, intravenous sedation, or local anesthesia.
After your surgery, some dressing is applied on your incisions and your head may be loosely wrapped to minimize swelling. You can put cold packs around the eyes for a couple of days after the surgery to reduce the swelling. You may experience a mild level of pain and discomfort during this time which is manageable with over the counter medications. Your surgeon may put tiny tubes on the incisions to drain excess fluids from the wound which he or she will remove in your first follow up visit. Temporary bruising and swelling are noticeable mostly under the eyes for the first four to five days but will gradually disappear. It’s better if you keep your head in a raised position while resting in the first two weeks after your surgery.
You may wash your head the next day and return to work within 2-3 days. Within 7-10 days after the surgery, all sutures are removed and the majority of bruising and swelling will have subsided. You can drive after the first week. However, strenuous physical activity should be avoided for six weeks. You should limit sun exposure for several months after the surgery to avoid hyperpigmentation of the forehead which can occur as a result of sunlight exposure during the first three to six months after the procedure.
You may feel numbness on the area of the incisions which is usually temporary. In some cases, it may take about 9-12 months to get back to normal. In some cases, the numbness will take longer and in rare cases, it may even be permanent. In the first few weeks, it is normal to feel itchy around the incision area as the nerves start to reconnect and heal.
Like any other surgical procedure, though infrequent, complications may occur and they include: Fluid retention or excessive loss of blood and fluids, infection, reaction to anesthesia medications, pigmentation changes (hypo/hyper), skin numbness – this is to be expected and is usually only temporary.
Some potential complications specific to brow lift surgery include:
- Persistent dry eyes
- Permanent muscle weakness or areas of permanent numbness are possible.
- Facial nerve injury that my lead to weakness of the lower lip muscle in very rare occasions
- Temporary or permanent hair loss at the incisions
- Facial asymmetry