Brow Lift (aka forehead lift, foreheadplasty) is a procedure designed to reposition and reshape the brows restoring a more youthful rested appearance. Brows (eyebrows) frame the face. Drooping brows can make you look angry, sad or tired. Drooping brows can also hide the beauty of the upper eyelid as the brow skin descends onto the upper eyelid, making it appear less defined. Often, patients think that they have excess eyelid skin that needs to be removed when the reality is that they need a brow lift. The upper eyelid and brow position are intimately related, and each affects the other.
If upper eyelid skin is removed in the presence of a drooping brow, it can actually pull the brow down. Surgical brow lifts must be conservatively performed to create a natural appearance. Often times the goal of a forehead or brow lift is to stabilize the brow providing a modest elevation. At no time should a brow lift exaggerate the brow position. A brow lift can be performed as a stand-alone procedure or in combination with facelift or eyelid surgery.
In select patients, a brow lift can be performed under local anesthesia.
When a minimal amount of lift is needed this can be achieved with either Botox, Dysport or Xeomin (all have similar action) and in some instances with the addition of filler or fat transfer.
What a brow lift does?
- Restores beauty to the upper eyelids
- Reshapes the brows
- Enhances facial expression
- Corrects a sad or angry expression
- Rejuvenates the upper eyelid and forehead
How is brow lift surgery performed?
Brow lifts can be performed in a variety of ways, depending on the patient’s anatomy and surgeon preference.
Coronal Incision – open approach:
This technique is reserved for patients who have particularly heavy thick tissues or who have had a previous coronal brow lift. An incision is made from ear to ear within the hair-bearing scalp. The forehead tissues are then elevated, and any modification of the underlying muscles is performed. For patients with a high forehead, the incision can be made just within the hairline preventing the hairline from shifting upward and elongating the forehead. This approach also permits actual lowering of the hairline in a patient who has a very high forehead.
Endoscopic technique:
In this technique, surgeons use an endoscope, a thin tube with a camera at the end. Several small incisions are made within the hair-bearing scalp. The endoscope is inserted through one of these incisions. Through the other incisions, the surgeon inserts instruments that are used to modify muscles beneath that act to pull forehead downward, as well as to reposition/reshape the brow. The surgeon visualizes what she/he is doing on a video monitor.
Limited incision foreheadplasty:
Similar to an endoscopic brow lift small incisions are made in the scalp. Through these incisions instruments are used to elevate the forehead tissues and secure them in place. In this technique, the surgeon directly visualizes the tissues through one of two slightly longer incisions.
Transpalpebral approach:
In this method, an incision is made within the natural crease of the upper eyelid as it is in upper eyelid surgery (blepharoplasty) The forehead tissues are elevated at a level just overlying the bone (subperiosteal level). A minuscule bioabsorbable implant, an Endotine implant with three tiny prongs called tines (little “hooks”), is anchored directly to the underlying bone. The tissues are then suspended on the tines. If indicated, residual upper eyelid skin can be removed during the same procedure. This procedure is best suited for patients with mild drooping of the brow, in particular, for patients who have significant hair loss or are bald.
Incision within the forehead creases:
This infrequently used technique is reserved for patients who may not be candidates for the above techniques. Bald men with very deep forehead creases may be candidates. The incision is made within a crease located on each side of the forehead through which the underlying tissues are modified and the brow elevated. This is reserved for patients who have deep creases in the forehead and who are predisposed to favorable healing.
Direct skin excision above the eyebrow:
An ellipse of skin is removed directly above the eyebrow. This technique can be used to make minor modifications of brow shape or position. Unlike the above techniques, it is performed under local anesthesia. Despite meticulous attention to detail, there is the possibility of a visible scar. This technique is very infrequently performed.
What type of anesthesia is used?
Brow lifts are usually performed under intravenous anesthesia or general anesthesia, administered by an anesthesiologist. In select patients, brow lifts can be performed under local anesthesia.
Where is the procedure performed?
Brow lift procedures are usually performed in a certified office facility, an outpatient surgery center or the hospital outpatient facility.
What kind of aftercare will I need?
Head elevation and cold compresses for the first 48 hours will help reduce swelling and bruising. Homeopathic treatments such as arnica and bromelain may reduce bruising and swelling and overall recovery time. You may shower and gently shampoo your hair the morning after your brow lift. No dressings are needed, and a topical antibiotic ointment is applied to the incision sites two to three times a day. A family member or friend should stay with you the night of your surgery, as well as for the following day or two. When performed in conjunction with a facelift and eyelid surgery, some plastic surgeons advise that a professional plastic surgery nurse stays with you the night of your surgery.
When will you look presentable?
Patients look presentable at 7 to 10 days after a brow lift or when performed in combination with eyelid surgery. Swelling gradually resolves over the first week. While there is usually little or no bruising of the forehead, you can expect bruising of the upper and lower eyelids, even if no eyelid surgery is performed. Cold compresses, Arnica, and Bromelin (homeopathic agents), facilitate resolution of swelling and bruising. For more important social events, three to four weeks is suggested.
When can I resume my everyday activities?
Within seven days, most patients can return to non-strenuous every-day activities. Activities that require bending, or tend to raise your blood pressure and heart rate should be deferred for at least two weeks.
