Brow & Forehead Lifting

Of the 3 D's of the aging face; Deterioration, Descent and Deflation, Descent is the major component of the aging brow.  Deterioration of the forehead skin and deflation due to fat loss around the eyes most certainly contributes to the sagging brow but the descent of the eyebrow is usually the primary feature corrected in the significantly droopy forehead.

1.  What is a brow and forehead lift?

2.  Why is brow and forehead lifting performed?

3.  Who is a candidate for brow and forehead lifting?

4.  What is an “ideal” eyebrow contour?

5.  What are the different techniques of brow and forehead lifting?

6.  Where is brow lifting performed?

7.  What is the post-operative care after a browlift?

8.  When can I resume normal activities following a browlift?

9.  What are the risks and potential complications from a brow and forehead lift?

 

 1. What is a brow and forehead lift?

Brow lifting is a surgical procedure performed to elevate the eyebrow and forehead.It is performed to correct a low, drooping, sagged, or aged eyebrow appearance.In all cases the brow is raised to a more aesthetically pleasing position. Brow and forehead lifting is performed for both cosmetic and functional purposes.In many cases the patient presents with a low or sagging eyebrow and wishes for it to be raised for an improved aesthetic appearance.In other cases a brow lift is considered a functional surgery whereby the patient presents with more severe brow drooping that compromises their visual field.In these cases, the correction may be covered by medical insurance. Brow lifting is performed as an outpatient procedure. Typically this type of surgery is completed under general anesthesia.The procedure takes approximately two hours to complete.

 2. Why is brow and forehead lifting performed?

A Brow and Forehead lift rejuvenates a drooping or wrinkled eyebrow and forehead, helping you to look less tired, angry or aged.Using either conventional (open) or minimally invasive (endoscopic) methods, brow lifting involves the alteration of the eyebrow and forehead by removal or movement of skin and alteration of muscles above and between the eyes.The result is smoothing of the forehead lines, lifting and redraping of the eyebrows for a more youthful and refreshed appearance. Brow-lifting surgery has the ability to modify the height of the hairline.In some women, for example, the forehead is high compared to the standard height of the ideal female forehead.In other words, the female forehead appears to be receding.In these cases, a pretrichial incision (incision placed in the midst of the hairline) has the ability to lower the hairline by excising (removing) a portion of the upper forehead skin causing the excessive forehead height.Brow and forehead lifting is often combined with other procedures such as blepharoplasty (eyelid lift) and face lifting for additional facial rejuvenation.

3.  Who is a candidate for brow and forehead lifting?

Brow lifting is typically performed on patients 40-60 years of age to counteract the effects of aging.However, anyone with a significantly droopy forehead and brow, lined or inelastic skin on the forehead, whether caused by aging, excessive muscle activity or inherited conditions are eligible.

4.  What is an “ideal” eyebrow contour?

While individual genetics play a central role in the appearance of your eyebrow, the ideal aesthetic female eyebrow tends to start broad and club shaped by the nose and located at or just above the orbital bony rim.The eyebrow continues as a pleasant, thinning arch peaking in the lateral (outside) third located above the orbital bony rim.The peak is located at a point measured by a vertical line drawn through the outer colored portion of the eye.The brow finishes as a taper as it approaches the outer portion of the face leaving the peak at a 45-degree angle.The outer edge of the eyebrow should be approximately 1 small finger width above the rim of the eye socket.In male patients the brow is less complex.The male eyebrow is flatter in contour and sits along the orbital rim as compared with the female brow.

5.  What are the different techniques of brow and forehead lifting?

No one brow lifting technique is superior to the others.The below discussed techniques are all acceptable and commonly performed.The decision to utilize one technique over another is based on multiple factors.During your consultation with Dr. Mitchell, a thorough discussion of your options will be presented.

Coronal brow lifting is a time honored and direct method of raising the forehead and eyebrow.With this technique, not only can the forehead and eyebrow be lifted, but an excessively long forehead can be shortened.With a coronal brow lift the incision is placed either behind the hairline or just within the front of the hairline. Access to the muscles between the eyes that cause scowl or frown lines is direct and easier compared to an endoscopic approach.Division of these muscles is typically completed in order to obtain a smoother, less wrinkled result. This technique tends to result in a very long lasting result.The disadvantage of this technique is a longer scar and more post-operative sensation loss.Typically, the numbness experienced following a coronal brow lift is temporary and resolves within 6-9 months.The possibility of permanent sensation loss behind the incision is possible. The following brow lifting techniques are options.The one technique ultimately selected is based on multiple factors that will be discussed during your consultation.

Endoscopic Brow Lifting - The procedure known as an Endoscopic Brow and Forehead Lift is performed through five one-half to one inch incisions hidden behind the hairline.The main advantage is that the scars are not easily noticeable.After the incisions are made, a small camera is placed under the skin along with another of several small instruments used to complete the necessary work to reposition the brow and forehead.With this procedure the positioning of the eyebrows can be secured and the look of being tired, sad or angry can be alleviated.This procedure is usually combined with the division of the glabellar muscles, which are the muscles that cause scowl or frown lines.The results of the combination of these procedures are a more aesthetically pleasing brow and a more youthful refreshed appearance.One disadvantage to an endoscopic browlift is the fact that the hairline is moved back 1-2 centimeters.While this amount of hairline shift is typically not very noticeable, it will create an even longer forehead in a woman with a pre-operative high hairline.

Mini Brow Lift – A mini-browlift is a less invasive procedure designed to raise the brow and/or the forehead that require less initial elevation.There are various methods for accomplishing a mini-browlift.A mini-browlift results in less trauma and therefore a shorter recovery time versus the coronal or endoscopic browlifting techniques.The first technique is called a Transblepharoplasty Browlift.This approach utilizes an incision made in the upper eyelid crease of each eye in order to gain access to the eyebrow.Unique absorbing fixation devices are used to hold the brow in its new position while the brow heals at its new level.The Transblepharoplasty Browlift technique allows for two procedures through one incision.Both a blepharoplasty (eyelid lift) and the browlift may be accomplished by utilizing only one incision on each side.

The second mini-browlift technique is like a facelift for the eyebrow.It involves making an incision within the hairline but not as long or as deep as a classic coronal browlift.The incision is fashioned in such a way where the scar is typically barely noticeable. This technique allows for some brow elevation without elevating the hairline and less post-operative discomfort and healing time.

Mid Brow Lift- A mid-brow lift is best used in patients with deep forehead creases.These patients are typically male.This technique involves making incisions directly on the forehead, fashioned around pre-existing forehead wrinkles.The advantage is a less invasive, direct brow-lift technique.The disadvantage is the possibility of unacceptable scarring on the forehead.Overall, this procedure works quite well for the properly selected patient.

6.  Where is brow lifting performed?

Brow and forehead lifting is a surgical procedure typically performed in an accredited outpatient surgical center.Some cases of transblepharoplasty browlifting (raising the eyebrow through an incision on the upper eyelid) can be performed in an office-based setting using local anesthesia.

7.  What is the post-operative care after a browlift?

It is important that you be sufficiently prepared for your postoperative recovery period.Post-operative instructions will be provided in written form prior to surgery. The day of surgery you will feel sleepy from the anesthesia. For the first few days you should be on a soft diet until your swelling and soreness resolve.Following a brow and forehead lift a head wrap will be applied and kept in place for the first 24 hours. Except for a brief peek, keep away from mirrors. Everyone experiences a temporary surprise when viewing a slightly bruised, swollen appearance in the mirror. Remember that a more attractive, youthful "you" will show through in several days.Cool compresses applied intermittingly to the eyes and/or forehead is recommended for the first 48 hours after surgery. Ice bags should never be used against the skin, as the area may be numb due to surgery, local anesthesia and swelling.Showering with warm water is allowed on the first post-operative day.Gentle shampoo may be used. Towel dry only for at least three days following surgery. You can resume use of a hair dryer after three days, but use only a cool setting until all feeling returns to the scalp area to prevent burns. Hair can be styled loosely two to three weeks after surgery, but do not use tight hair rollers or perm or color your hair for six weeks. Glasses can be worn as long as the stems do not irritate your ears.Pain medication and prophylactic antibiotics will be prescribed and should be taken as directed. Sleeping with the head elevated will help reduce post-operative swelling and bruising.No strenuous activity is allowed for two weeks following surgery.Facial moisturizer can be used immediately after surgery. Three days later you can apply make-up to camouflage bruising as long as it does not cover incision lines. Our office can suggest facial care products.

8.  When can I resume normal activities following a browlift?

The answer to this question depends on what you consider normal.Bruising and swelling may dissuade you from working with the public for the first week after surgery.Office work and light activity can be resumed 2-3 days after surgery.No strenuous activity is allowed for 2 weeks following surgery.Strict sun avoidance for 4 weeks is necessary and sun block is always recommended on exposed skin.Lifting greater than twenty pounds is not allowed for the first two weeks.

9.  What are the risks and potential complications from a brow and forehead lift?

As with any surgical procedure, risks and potential complications include post-operative bleeding, infection, and scarring.Hair root damage is unusual but possible. Sensory nerve damage occurs most commonly with an open, coronal browlift and to a lesser extent with the other techniques.Sensation typically returns from within 3-12 months.Motor nerve damage (nerves that control movement) is a rare complication, is typically temporary but could be permanent.

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