An operation designed to rejuvenate the upper part of the face by reducing the wrinkles on the forehead and improving the position and shape of the low sagging eyebrows.

  • for people with sagging or low eyebrows and deep creases across the forehead
  • drooping brow gives the face a sad and tired look
  • get an idea of how brow lift would affect your look, by putting your hands above your eyebrows and raising the skin upwards
  • usually done in general anesthesia in 1-2 hours
  • a moderate lift of the outer part of the brow can be done in local anesthesia
  • incisions are hidden in hair bearing area, sometimes an endoscope is used
  • you can return to work and normal activity after two weeks
  • forehead lift is frequently combined with a blepharoplasty to achieve maximum aesthetic improvement

What is brow (forehead) lift?

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.

Who is a good candidate for brow (forehead) lift?

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,
  • eyebrow asymmetry.

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.

How to asses the shape and the position of the brows?

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 and lies just above bony ridge over the eye. Male brow is commonly located at the orbital rim. Ideally shaped eyebrows in females are gently arched with the highest point above the outer edge of the colored part of the eye (iris). Men have flatter eyebrows.

Brow lift vs. upper blepharoplasty

Brow ptosis is common in the general population increasing in the prevalence after the age of 50 years. Frequently patients come for an upper eyelid surgery unaware, that their heavy eyelids are due to excess skin on the forehead and descended eyebrows. Often the apparent excess of skin on the upper eyelids is a consequence of a brow malposition and can be partially or completely addressed with a brow lift. Brow lift has to be considered as a primary or adjunctive procedure when evaluating the patients with periorbital ageing.
It is important to understand how brow ptosis can affect the upper eyelid, as blepharoplasty alone could fail to fully correct the problem or even pull down the brows further, resulting in an unwanted tired look. When manually lifting the brows to the proper position improves the look significantly, brow lift should be considered. It can be done alone or in combination with the blepharoplasty, depending on the excess skin remaining on the upper eyelid following the brow lift. When combined, brow lift has to be done first to prevent removing too much skin from the upper eyelids.

How is a browlift performed?

Brow (forehead) lift procedures range from simple direct removal of excessive skin above the brow to more complex endoscopic techniques with short incisions.
Depending on the specific situation various degrees of skin undermining and removal is 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 permanently. Minor operations can be done in local anesthesia, for more extensive procedures general anesthesia or intravenous sedation in combination with local anesthetic is preferred.
The most common variations of the brow (forehead) lift procedure are:
Direct excision is suitable for older patients troubled by drooping eyebrows. It is not a common choice for younger patients as more obvious scar will likely develop. Lemon slice-shaped excision is made precisely at the upper edge of the eyebrow to remove the extra skin above and rise the brow position. This operation is performed in local anesthesia.
Transpalpebral browlift. The upper blepharoplasty incision can be used to correct a moderate droopiness of the brows.

Bicoronary browlift has long been considered a standard procedure. It is rarely used nowadays as endoscopic browlift is currently the preferred choice of most surgeons. It involves a long incision in the frontal hair-bearing scalp and allows for a direct visualization of the deep structures. The downside is a longer recovery and elevation of the hairline. For this reason this approach is more suitable for patients with low hairline.
In a variation of this procedure the scar is placed in the frontal hairline. The advantage is that a very high forehead can be lowered by the removal of excessive skin. The scar can be a problem in patients who wear their hair pulled back .
Temporal lift is an effective procedure for isolated descent of the outer part of the brow. The incisions are placed in the temporal hair bearing area. It is often done in conjunction with facelift.
Endoscopic brow (forehead) lift. Minimal incisions only are necessary to achieve results similar to the traditional techniques. Endoscope is inserted in the hair bearing area through tiny incisions. It is tunneled beneath the skin, preserving the sensory nerves to the scalp. The image on a video screen enables the surgeon to clearly see the deeper structures. To rejuvenate the whole upper part of the face a midface lift can be added as an extension of the procedure.

Can only the frown lines be corrected?

Frown lines between the eyebrows or across the top of the nose can be corrected with the endoscopic surgical procedure. The brow can be lifted simultaneously if necessary. The results of the surgical frown lines correction are permanent compared to botox injections.

What are the potential risks and complications?

As with other types of surgery there are some rare complications such as accumulation of blood under the skin, bleeding and infection. A certain degree of swelling and bruising is expected in the first few days after the surgery. Reduced sensitivity of the forehead and frontal parts of the scalp usually resolves within several months. Altered function of the nerve (upper branch of the facial nerve) that wrinkles the forehead is not common but can occur.

What is recovery after brow (forehead) lift?

Surgery can be done as an outpatient procedure, but we sometimes recommended an overnight stay. Bandages are applied after the procedure. Brow lift is not very painful. We prescribe pain medications to be taken if needed to assure the most comfortable recovery. The 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 bruising subsides. Brow (forehead) lift incisions are concealed in natural skin creases and in the hair bearing area. Because of excellent blood supply of this region, the incision tend to heal with good quality scars.

Can brow lift be performed in combination with other procedures?

A blepharoplasty is sometimes done with the brow lift to further enhance the rejuvenation of the eyes. Brow lift surgery is often combined with a facelift to address the lower part of the face. It can also be combined with a variety of facial rejuvenating procedures to achieve a balanced and natural result.

How long will the results of a brow lift last?

Aging continues its normal course 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. The upper part of the face will always look fresher as it would without the procedure.

Are there non-surgical alternatives to brow lift?

Some signs of aging described above can be temporarily improved with botulinum toxin injections. To address these changes permanently a forehead/eyebrow lift is recommended. Significant droopiness of brows can not be improved without the surgery. Other minimally invasive procedures such as fillers and skin resurfacing are frequently used in conjunction with brow lift to further enhance the results.

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