Browlift (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 falls onto the upper eyelid making it appear less defined. Often, patients think that they have 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 browlifts must be conservatively performed to create a natural appearance. A browlift can be performed as a stand-alone procedure or in combination with facelift or eyelid surgery.
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 a filler or fat transfer.
What a browlift does
- Elevates brow position
- Reshapes the brows
- Enhances facial expression
- Corrects a sad or angry expression
- Restores beauty to the upper eyelid
- Rejuvenates the upper eyelid and forehead
How is browlift surgery performed?
Brow lifts can be performed in a variety of ways depending on the patient’s anatomy and surgeon preference.
oronal Incision- open approach:
An incision is made is made from ear to ear across the head within the hair-bearing scalp. The forhead 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 becoming any higher. This approach also permits actual lowering of the hairline in a patient who has a very high forehead. This technique is particularly beneficial for the patient who has very thick heavy tissues.
In this technique surgeons use an endoscope, a thin tube with a camera on 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 tissues beneath the scalp 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 within 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.
In this approach an incision in made within the natural crease of the upper eyelid as it is in upper eyelid surgery (blepharoplasty).The forhead tissues are elevated at a level just overlying the bone (subperiosteal level). A very small bioabsorbable implant, an Endotine implant with three tiny prongs called tines, is placed underneath the brow and it is anchored directly to the underlying bone. The tissues are then suspended on the bioabsorbable implant. 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 technique is reserved for patients who may not be candidates for the above techniques. Bald-headed men who have very deep forhead creases may be candidates. The incision is made within a crease located on each side of the forhead through which the underlying tissues are modified and the brow elevated. This is reserved for patients who have deep creases within 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.
Where is the procedure performed?
Browlift procedures are usually performed in a certified office facility, an outpatient surgery center or in 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. You may shower the next morning after your browlift. 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 Dr. Bruck advises that a professional plastic surgery nurse stay with you the night of your surgery.
When will you look presentable?
Patients generally 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 every-day 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.