The brow lift is also known as a forehead lift or browplasty, and is a cosmetic surgery procedure used to elevate a drooping eyebrow that may obstruct vision and/or remove the deep wrinkles that run across the forehead. The procedure changes the position of the soft tissues of the forehead and thereby the appearance of the upper face, also reducing sagging of skin in the eyebrows and above the nose.
A youthful brow at rest is positioned above the orbital rim, with a gradual arch laterally, and the lateral end is located higher than the medial end. It is common for the brow to assume a flat or horizontal position as one ages. Every year, thousands of people undergo successful brow-lift surgery and are pleased with the results.
Brow Lift Techniques
There are various brow-lift methods, involving different length incisions in different locations and sometimes an endoscope. The procedures have evolved from open techniques to more complex short incision and endoscopic techniques. A brow lift usually involves incisions in the hair-bearing scalp, but sometimes incisions are made in the forehead and/or the upper eyelids. Brow lift procedures can be:
- coronal forehead lift
- direct browlift
- endoscopic forehead lift
- mid-forehead lift
- pre-trichal lift
Coronal Forehead Lift
The surgeon performs an ear to ear incision across the top of the head and elevates the entire forehead and brow. Depending on where the hairline is located before the surgery, the elevated hairline may or may not produce a desirable appearance. The advantage of this technique is that incisions are not made on the face. The disadvantage is that a large area of the skin and underlying tissues in the forehead must be loosened in order to elevate the brows. Another disadvantage is that the position of the hairline will be raised as the loosened tissues are stretched toward the top of the head.
For women with very high foreheads, an incision just at the anterior hairline may be recommended. This way, the brow can be lifted without altering the height of the front hairline. There will, however, be a more visible resulting scar.
Direct Browlift
A direct browlift is performed by removing a segment of skin and muscle just above the eyebrows. The incision is hidden within the brow hair. Surgical scars may be prominent. The technique does not address wrinkles or lines within the forehead and it is typically reserved for older patients or for men with thick eyebrow hair and male pattern baldness for whom other techniques might result in unacceptable elevation of the hairline.
Endoscopic Forehead Lift
This technique involves the use of instruments along with a surgical endoscope placed under the forehead skin through small incisions. The surgeon loosens the forehead skin, elevates the brows and smoothes forehead wrinkles by stretching the loosened forehead tissues upward, toward the top of the head. This procedure has the advantage of a faster healing, smaller incisions and less bleeding. The disadvantage of this technique is that the patient’s hairline may be elevated higher than is cosmetically desired.
Mid-Forehead Lift
Recommended for patients with heavy sagging eyebrows and deeper forehead wrinkles, the procedure involves incisions within the deeper forehead wrinkles and removing of the excess skin, fat and sometimes muscle. The surgeon makes incisions within the deep wrinkles so that the resulting scars are concealed within the skin lines. The advantage of this technique is that less of the forehead tissues need to be loosened and less skin needs to be removed.
Pre-Trichal Lift
The pre-trichal lift is a version of the coronal forehead lift and requires an incision in the skin in the upper forehead, just in front of the hairline. The advantage is that the position of the hairline is not modified. The sides of the incisions may be made either in front of the hairline at the temples or behind the hairlines. Thus, loose forehead skin is stretched upward and removed just in front of the hairline.
Brow Lift Surgery Steps
A brow lift procedure includes the following steps:
- anesthesia
- the incisions
- closing the incisions
Medications will be administered for your comfort during the surgical procedure. Your surgeon will suggest either intravenous sedation or general anesthesia. The surgeon will follow the surgical plan discussed with you prior to your procedure. Once the surgery has begun, the surgeon may decide to combine various techniques to ensure the best result.
Sections of hair will be held away from the surgery area, and after removing excess tissue, skin and muscle, the surgeon will close the incision with stitches or staples, removable or absorbable sutures, skin adhesives, surgical tape or special clips. The sutures are usually removed within 7 to 10 days following surgery. If bandages have been used, they are removed in 1 to 3 days. Patients must follow the advice of their surgeon on resuming normal activities. Recovery time will not exceed 2 weeks, but strenuous activities should be avoided for longer periods.
Risks and Safety
Complications are said to be rare and minor during and after the procedure. It is possible for the surgical process to damage the nerves that control eyebrow and forehead movements, hair loss may occur along the scar edges and, as with any surgical procedure, infection and bleeding are possible. You will be asked to sign consent forms to ensure that you fully understand the procedure and any risks and possible complications. Brow lift surgery risks include:
- anesthesia risks bleeding
- elevated hairline
- facial asymmetry
- facial nerve injury with weakness or paralysis
- fluid accumulation
- loss or hair around the incisions
- numbness and changes in skin sensation
- persistent pain
All the risks will be discussed fully prior to your consent. It is important that you address all your concerns and questions directly to your surgeon.
Preparing for Consultation and Surgery
During your consultation, you should be prepared to discuss your goals for your appearance, your complete medical history, your current medications, vitamins, herbal supplements, alcohol, tobacco and drug use. Your surgeon will also evaluate your general health status, discuss your options, examine and measure different parts of your face, take photographs for your medical records, recommend a course of treatment and discuss the likely outcomes of your surgery.
Your surgeon will provide thorough preoperative instructions. You can expect instructions such as:
- if you smoke, you will be asked to stop at least 6 weeks before your surgery
- you will be asked to limit alcohol consumption and avoid certain medications
- you will be asked to stop taking aspirin and other anti-inflammatory drugs
- if your hair is short, you may want to grow it out to cover any scars
- for a safe recovery, you will be asked to keep yourself hydrated before and after surgery
- you will need to make arrangements to be driven to and from surgery on the day of your procedure
- you should have someone to take care of you on your first night home
- you will be asked to set up your recovery area ahead of time and prepare icepacks to reduce postoperative swelling
One month following the surgery, you should have returned to your normal work rhythm, depending on the amount of physical exertion required to perform your duties. The final result from surgery will be evident after 6 months. By then, the scalp and hairline incisions will have healed completely.
Am I a Candidate for a Brow Lift?
The following are some common reasons why you may want to consider a brow lift:
- you have frown lines between your eyes
- the central position of your brow hangs down, making you look angry
- the outside of your brow sags
- if you are a female and you are unable to apply makeup on the upper eyelid, because the surface of the area has been obscured by drooping tissues
You may be a candidate for brow lift if you are physically healthy, are a non-smoker and have a positive outlook and realistic goals regarding your surgery. Rely on an evaluation from a board-certified plastic surgeon to find out if you would benefit from a brow lift.