Also known as a forehead lift, a brow lift, is a surgical procedure designed to improve the position and shape of the low sagging eyebrows and recontour the skin of the forehead, to minimize forehead creases, especially those between the eyebrows. This results in more rested, youthful and less sad appearance. The forehead will however, continue to move with facial expressions and emotion.
Good candidates for forehead or brow lift are people who have sagging or low eyebrows, deep horizontal creases across the forehead, frown lines, deep furrows between the eyebrows and across the top of the nose. Usually they have an overall tired or sad appearance. A forehead lift is also appropriate treatment for young people with hereditary low eyebrows and those who already have deep frown lines due to stress or over activity of the muscles. Some individuals with sagging eyebrows contract the forehead muscles continuously to help lift their brow. This creates even deeper wrinkles of the forehead and an anxious appearance when relaxed. Frequently patients come for an upper eyelid surgery unaware, that their heavy eyelids are due to excess skin on the forehead and brow or forehead lift is the proper procedure to address their problems.
While looking in the mirror the effect of the operation can approximately be demonstrated by pulling the eyebrows upward and outward. There are no exact rules for the ideal location of the eyebrow, but the usual distance between the center of the pupil and the eyebrow is two to two and a half centimeters. The position of woman’s eyebrows is higher than man’s that are commonly located at the bony ridge over the eye. Ideally shaped eyebrows in females are higher at the center and outer end than at the inner end.
At the pre-operative consultation, skin texture, elasticity and thickness, extent of wrinkling, position of the eyebrows and hairline, facial bone structure, eyelid and eye aesthetics should be assessed by a qualified plastic surgeon. According to unique features of ageing and aesthetic goals a surgical procedure or combination of procedures to obtain the best results with lowest potential risk should be proposed.
For brow (forehead) lift general anesthesia or intravenous sedation in combination with local anesthetic is preferred. There are many different variations of the brow (forehead) lift procedure. They range from open techniques to more complex short incision and endoscopic techniques. Incisions are hidden in natural creases or hair bearing area of the scalp. According to a specific situation various degrees of skin undermining are performed, deeper layers of the forehead are repositioned and secured to underlying structures, eyebrow position is corrected and muscles that cause wrinkling and frown lines are disrupted. To rejuvenate the whole upper part of the face a midface lift can be added as an extension of the procedure. An endoscope, is usually used for this procedure. Endoscope is inserted in hair bearing area through tiny incisions. It is tunneled beneath the skin, enabling the surgeon to see deeper structures on a video screen. Only relatively young individuals with a very limited amount of skin sagging are candidates for this procedure also named endoscopic facelift. A forehead lift is frequently combined with a blepharoplasty to achieve maximum aesthetic improvement. Instead of a major procedure a local eyebrow lift in local anesthesia can be performed in older patients troubled by drooping eyebrows. Incision is made precisely at the upper edge of the eyebrow in order to remove extra skin above it. This technique is not suitable for younger patients since more obvious scar will likely develop.
If the main problem are the frown lines between the eyebrows or across the top of the nose, an endoscopic procedure to address these problems can be performed. Compared to botox injections results of this procedure are permanent.
Some swelling and bruising is expected in the first few days after surgery. Reduced sensitivity of the forehead usually resolves within several months. Some patients are troubled by headaches during the first week. Altered function of the nerve (upper branch of the facial nerve) that wrinkles the forehead is not common but can occur. Generally the muscle activity returns over time. Some potential but rare complications are accumulation of blood under the skin, infection and bleeding.
Surgery may be done as an outpatient procedure, but we recommended an overnight stay. Bandages are applied after the procedure, and soft drains are placed to remove excess fluid. Drains are removed in one or two days. Brow lift is not very painful, and pain medications are also prescribed for painless healing. Most stitches are removed within a week of the surgery. Cosmetics can camouflage any bruising that remains. You will be ready to return to work and normal activity after approximately two weeks. Over a few weeks, visible improvements of the brow lift will be evident, as mild swelling and any bruising subsides. Brow (forehead) lift incisions are concealed in natural skin creases and in hair bearing area. Because of excellent blood supply of this region, the incision tend to heal with good quality scars.
Very often a blepharoplasty is done with the brow lift to further enhance the results. Brow lift surgery is often combined with a facelift to address also the lower part of the face. It can also be complimented by a variety of surgical facial rejuvenating procedures.
Aging continues as appropriate after any type of aesthetic procedure, but the benefit of the operation remains. The effect of the brow lift is likely to always be there, in that you will not look as old as you would have if it had not been carried out.
Some signs of aging described above can be corrected temporarily with botulinum toxin injections, but to address these changes permanently a forehead/eyebrow is recommended. Other minimally invasive procedures such as fillers and skin resurfacing are frequently used in conjunction with brow lift to further enhance the results.