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Brow Lift

A brow lift is a procedure can restore a more youthful appearance and rejuvenate a person’s expression by creating a more youthful contour to the upper part of the face.  The eyes and forehead communicate our emotions.  And with aging a sagging or heavy brow can create the appearance of being tired or unhappy.

A brow lift can rejuvenate a person’s expression by creating a more youthful contour to the upper part of the face.  A patient can appear more refreshed, eyes appear brighter and often a more welcoming countenance is created.

EVALUATION

The shape and position of the brows are assessed, as they relate to the upper eyelid
and the orbital rim. Classically, the eyebrow should lie slightly above the bony rim of
the orbit arching gently upward and peaking somewhere between the edge of the iris
and the corner of the eye and then finishing slightly downward. This can vary
somewhat depending on the individual, their genetics, and their bone structure but is
a fairly consistent structure.

The position and the shape of the hairline is a major contributor to the decisions that
are made regarding the best technique and the incisions placements.

The severity of the wrinkles and their location will determine what will need to be
done to the underlying muscles to achieve the best result.

TECHNIQUE

There are various approaches to relocating the brow into its proper position. The
nature of the problem, the amount of brow drop, the number of wrinkles, and the
location of the hair line will determine the optimum technique.

There are three basic types of brow lifts which relate to the location of the incision.
The classic approach is the Coronal Brow Lift in which the incision is above the
hairline from one ear to the other. This is the most powerful operation of the three,
giving excellent exposure and control over the positioning of the brow and softening
of the wrinkles. It is best for those with low hairlines and a lot of wrinkling and brow
drooping. It is also best for those with asymmetry between eyes. The downside to this
is a longer incision and possible numbness in the scalp behind the incision.

A modification of the coronal brow lift is the Pretrichial Brow Lift, where the incision is
placed in the frontal hairline and then hidden in the temporal hair along the sides. It is
equally powerful, but it is best for those with higher hairlines who would potentially
end up with their hairline too high on the head. The hairline incision needs to be
blended well, as it can be visible when the hair is pulled back.

The third approach is the Endoscopic Brow Lift. The incision is the same as the other
two procedures in the temporal hair, but is broken up into three smaller incisions in
the frontal hair. The skin is elevated and released with the assistance of an endoscope
through which the muscles can be manipulated to improve forehead lines. Once this
has been accomplished, the scalp is repositioned to lift the brow and secure it in
place. This is best for patients who do not have an excessive amount of brow droop or
asymmetries between their brow position, but still require improvement in this area to
get the best result. It is not as powerful as the open approach brow lift operations, but
it avoids scalp numbness, a shorter incision, and no hair removal in the frontal area.

RECOVERY

As with all surgical procedures, healing is a gradual process which can be divided into
three stages. The initial phase of healing is primarily related to the level of bruising
and swelling you develop in the first few days. Minimization these two issues will
expedite your early recovery, so that you are presentable as soon as possible. This
typically takes one to two weeks.

After this the middle of the recovery is entered where your incisions will begin to fade,
residual swelling will diminish, and the skin will settle. You will notice gradual
improvement and a return to normal between two to six weeks. This part usually goes
unnoticed by the casual observer.

The final phase will take place over the remaining six months where the most subtle
changes will take place.

RISKS AND COMPLICATIONS

The most common problem, though rare, is related to unexpected bleeding in the
immediate postoperative period (first 24 hours). Blood can accumulate beneath the
skin putting stress on the incision and must be addressed as soon as possible. Drains
are usually placed along with a compression dressing to help prevent this from
happening.

The more serious potential complications are injury to nerves in the brow that control
either sensation of the skin or motion of the eye brow. This can be due to heat from
cautery, stretch from surgical manipulation, or direct injury. Most nerve injuries are
temporary, but can take several months to recover.

Hair loss in the area of the incision is a potential problem which can create a more
noticeable scar. It is not uncommon for some loss initially from the stress on the hair
follicles in the area, but this typically recovers in three to six months. After this time,
any permanent hair loss would have to be addressed with surgical procedures.

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