Q – What is a brow lift?
The brow lift, also known as a forehead lift or browplasty, is a plastic surgery procedure designed to rejuvenate the upper one-third of the face, or the area above the brow. The brow lift can elevate and reshape the brow to improve brow shape and/or heaviness or drooping of the brow.
Q – Who is a good candidate for a brow lift?
Healthy men and women who are bothered by a flattened brow and/or a brow that contributes to unwanted heaviness above the eye may be good candidates for a brow lift. Patients who are interested in a brow lift are often looking to improve a tired, sad, or aged look caused by unwanted heaviness of the upper eyelid. Many brow lift patients initially inquire about upper eyelid surgery, also known as blepharoplasty, as a heavy or drooping brow may be partially or entirely responsible for the cosmetic deformity along the upper eyelid region. It is not uncommon for patients to undergo a combined brow lift and upper eyelid lift. Some patients have excess eyelid skin and a heavy brow which contribute to impaired peripheral vision, in which case the surgery may be covered to some degree by insurance. Patients considering a brow lift or eyelid rejuvenation should be free of concomitant problems such as eyelid muscle weakness, dry eye, excess tearing and/or double vision.
There are a variety of brow lift procedure which can be performed to reshape the brow. The temporal brow lift mainly elevates the tail of the brow and is primarily reserved for female patients desiring a more feminine, gently arched brow. The endoscopic brow lift, which elevates the entire brow, may be performed on patients with a relatively vertically-oriented forehead which can facilitate the use of the surgical telescopes and instruments. The pretrichial and trichial brow lifts, which also elevate the entire brow, are performed using an open technique with a continuous incision and the removal of a defined amount of forehead skin. The pretrichial brow lift, which involves an incision made in front of the hairline, helps to elevate the brow while also shortening a high forehead. The trichial brow lift does not shorten the forehead but does elevate the brow through the removal of a defined amount of forehead skin. The direct and indirect brow lifts involve an incision placed just above the brow and within a well-developed horizontal crease. These are typically reserved for male patients, particularly those with male pattern baldness who may not be good candidates for the endoscopic, pretrichial or trichial brow lifts.
Q – Where is the brow lift procedure performed?
Most brow lift procedures are performed in an outpatient surgery center, though some limited brow lifts like the temporal brow lift may be performed as an office-based procedure.
Q – What type of anesthesia is used for the brow lift?
Patients may elect to have either deep sedation (twilight anesthesia) or general anesthesia. Local anesthesia is sometimes used for later temporal lift, direct brow lift and indirect brow lift procedures.
Q – How is the brow lift performed?
The exact nature of the brow lift surgery will depend on the technique used. For an isolated temporal brow lift, a narrow, elliptical-shaped incision is made in the temporal hair. The incision is carried down to a safe level that can be elevated toward the brow, allowing safe mobilization and elevation of the lateral brow. The tail of the brow is then suspended and repositioned in an upward and outward direction, and then stabilized with carefully placed sutures. Additional sutures or staples are used to close the scalp incision.
An endoscopic brow lift, also known as an endobrow, includes a temporal brow lift on both sides. An incision is made in the midline of the scalp along with an incision just off the midline of the scalp on the left and right sides. Working through the incisions, the forehead is safely mobilized with the help of narrow surgical telescopes that allow for visualization of the surgical dissection. The attachments keeping the brow down are released and, if there is excess activity of the frown muscles in between the brow, these are addressed by cutting the individual muscles. The brow is then lifted directly upward and stabilized in the new position. An absorbable suspension device, termed an endotine, is used to stabilize the new position of the central brow. The endotine slowly reabsorbs over the next several months. The lateral is suspended and stabilized with carefully placed sutures, the scalp incisions are closed, and a compressive forehead wrap is applied.
The pretrichial and trichial brow lifts involve incisions similar to those made for an endoscopic brow lift. Surgical telescopes are not used. Instead, dissection is performed though the longer incision under direct vision. The brow is released and the frown muscles altered similar to the endobrow, and the brow is then suspended according to how much skin is removed along the incision. Fine sutures are used to close the incision and a compressive wrap is applied to the forehead.
For a direct brow lift, incisions are carefully planned, marked and made along the upper border of the eyebrow, with the width of the curved incision corresponding to the amount the brow will be elevated. Skin is removed and the brow is lifted using permanent or semi-permanent sutures attached to the underlying muscle. Fine sutures are used to close the incision. The indirect brow lift is similar to the direct brow lift except the incision is placed within a well-formed horizontal forehead crease.
Q – How long does the brow lift take to perform?
The brow lift usually takes two to three hours to perform.
Q – Where are the incisions made for the brow lift?
The location of the brow lift incisions will depend on the technique used. The lateral temporal brow lift involves an incision that is hidden with the temple scalp hair. The endoscopic brow lift involves incisions which are entirely hidden within the hair, including three short incisions along the top of the scalp and a temple incision on each side. For the pretrichial and trichial brow lifts, a continuous incision is made which follows the front hairline contour and extends into the temple hair on each side. The pretrichial incision is made at the front of the hairline while trichial incision is made inside the hairline. A direct brow lift involves an incision which is placed immediately above the brow hair while an indirect brow lift placed the incision in a well-developed or deep horizontal forehead crease.
Q – Are there scars after a brow lift?
The incisions made during the brow lift will result in scars, the degree of which will depend upon the particular technique used. The incisions are generally placed so as to be well-concealed, often within or at the hairline or within a deep forehead crease.
Q – Is the brow lift a painful procedure?
Patients may experience some discomfort or pain which is well controlled with low-dose prescription medication.
Q – What is the recovery like after a brow lift?
Some amount of swelling and bruising, mostly around the eyes, is common during the first seven to ten days after the brow lift. Patients will be advised to sleep with the head slightly elevated to help minimize swelling. Patients can minimize swelling and bruising by avoiding blood thinners like aspirin and ibuprofen for two weeks prior to surgery. Taking Arnica Montana before and after surgery can also help to minimize swelling and bruising. Any pain or discomfort patients experience is well controlled with low-dose prescription medication. Some patients experience temporary thinning of the surrounding hair, but hair growth eventually return to normal density and appearance in nearly all cases. Patients may also experience some temporary numbness above the scalp incisions near the top of the head.
Patients will be seen within twenty-four to forty-eight hours after surgery for the bandages to be changed and to make sure that there is no unwanted bleeding along the surgical site. Within five to six days after surgery, the sutures will be removed and a lighter, removable bandage will be applied. Patients will be given instructions regarding wound care. Follow-up appointments will then occur every several weeks during the first few months.
Most patients are presentable in public after seven to ten days, and make-up can be worn at this point to help conceal any remaining bruising. Though the incisions concealed within the hair may feel slightly raised for a short period of time after surgery, the resulting scar will be less visible once the healing process is complete. For patients undergoing an endoscopic brow lift with an endotine device, the outline of the endotine device may be able to be felt initially but will fade as the endotine begins to absorb. Incisions made for the direct and indirect brow lifts may appear slightly pink for the first few days to weeks, but these will fade as the scar matures and remodels over the following months.
Q – When will I be able to return to work after undergoing a brow lift?
Work and other normal activities can usually be resumed within seven to ten days after the brow lift. Patients who are not bothered by the bandages may be able to return to work sooner.
Q – When will I be able to exercise after my brow lift?
Aerobic activity and recondition can usually be resumed within ten to fourteen days after the brow lift. Strenuous activity and resistance workouts may be resumed in about three to four weeks.
Q – When are the stitches removed after the brow lift?
The stitches are usually removed within five to six days after the brow lift.
Q – Are there risks or complications with the brow lift?
As with all types of surgery, there are potential risks associated with the brow lift. The risk of infection if very low and bleeding complications are quite rare provided that patients follow instructions to stop taking blood thinners for two weeks before surgery and stop smoking at least two to three weeks before surgery. Any surgery involving the brow and forehead carries the potential risk of damage to the frontal branch of the facial nerve which helps elevate the brow on a normal basis. This risk is quite low because surgeons can reliably predict the nerve’s path and alter their surgical approach to avoid its course.
Q – Does insurance cover the brow lift procedure?
Brow lift procedures are generally not covered by insurance when performed solely for cosmetic purposes. Some coverage may be available when excess skin of a heavy brow contributes to a loss in peripheral vision. This finding will need to be found on objective testing and examination with your physician.
Read more about browlift procedures.