“The position of the brow has a major impact on facial expression. An elevated, smooth, youthful looking brow conveys a positive, uplifted state of mind.”
The changes of the forehead and eyebrow area associated with aging include the formation of deep creases across your forehead and between your eyebrows, in association with skin laxity. There is also a gradual descent of your normal brow position that gives your eyebrows a “heavy” look.
A brow lift helps to reverse the aging process by tightening a sagging forehead, removing and softening some creases and lifting falling eyebrows. Younger people should also consider this procedure if they have inherited traits such as low eyebrow position or other problems such as deep frown lines. To temporarily halt wrinkles, botulinum toxin injections to the forehead area and between the eyebrows can also be performed along with soft tissue fillers that can plump up some of the creases that form between the eyebrows.
Brow lifts are commonly performed in conjunction with facelifts or eyelid surgery. When performed in the same operative session as an upper eyelid lift, the browlift should be performed first as it will tend to minimize the amount of upper eyelid skin that needs to be removed.
There are two basic techniques that we use for lifting the brow: the older, more traditional coronal brow lift and the endoscopic brow lift. The endoscopic technique for a browlift is most commonly used and it is advantageous because incisions at the scalp are minimized, there is less chance of permanent scalp numbness and the recovery period is shortened. This technique is also recommended for people with thinning hair. As with all surgery, there are many ways to achieve the same goals. We tailor our technique to the needs and particulars of each person.
Typically, a forehead lift can be performed under local anesthesia, combined with an intravenous sedative to make you drowsy, so that you are relaxed and unable to feel pain. The surgery can also be performed under general anesthesia. Your hair does not need to be shaved but is typically tied back with rubber bands on either side of your head where the incisions will be made.
With the coronal technique, a cut is made through the scalp slightly behind the natural hairline and runs from ear to ear across the top of the head, where a headband or headset would sit. For people with a high hairline, this incision can be made where the hairline begins to avoid moving the hairline back. After making the incision, the skin is lifted away from the underlying tissue and pulled tight, causing elevation of the eyebrows. The excess scalp tissue is trimmed away and then the incision is closed with stitches or staples. Usually, the suture line is covered with gauze and your head is wrapped in an elastic bandage.
Instead of one long incision, the endoscopic technique requires three to five one-inch incisions and is our technique of choice. To see the underlying muscles and tissues, we insert an endoscope (a wand with a small camera on the end) into one of the incisions. In another incision, we insert a different instrument to lift the skin and release the underlying muscles and tissues. Next the eyebrows are lifted and secured underneath the skin. We have incorporated the Endotineâ„¢ device (Coapt Systems) into our browlift procedures for added fixation (see below). Gauze and elastic bandages are then applied.
This technique involves placing a small absorbable device which holds tissue in place through a single upper eyelid incision while doing a standard upper eyelid lift. A transblepharoplasty brow lift also eliminates the frown lines between the eyebrows. The ENDOTINE transbleph is a revolutionary device that is placed underneath the brow and anchored directly to the underlying bone for secure brow elevation with minimal surgical manipulation of the tissues. Standard suture material can also be used to do the “lifting”. Surgeons using the upper eyelid as access for a browlift can achieve the combined procedure of removing upper eyelid skin and repositioning of the brow in a single surgical session with a minimal amount of scarring.
By making a limited incision just behind the natural hairline in the area of the temple, the outer part of your eyebrows can be elevated. This technique is mainly intended for people with slight droopiness specifically on the outer aspects of their eyebrows but without a general overall lower position of their eyebrows.
To reduce swelling, you will need to keep your head elevated. Bandages are removed within a few days and stitches or staples are removed within a week. Within a couple of days you can shower and shampoo your hair. Numbness, tightness of the forehead and temporary pulling around the stitch line are common. Your cheeks and eyes may also swell and bruise, but these effects should resolve within a week or so. While the hair around your scar may thin, hair growth should resume within a few weeks or months. Most people are up and about in a few days, but you should rest for at least the first week after surgery. Rigorous physical activity should be avoided for several weeks. Most of the visible signs of surgery should fade within the first three weeks.
There is a possibility that the nerves that control eyebrow movement may be injured on one or both sides, which may result in an inability to raise the eyebrows or wrinkle the forehead. This is usually a temporary condition, but may be long term or permanent in rare cases. You may have a loss of sensation along or just beyond the incision line is common, especially with the coronal type of brow lift. Scalp numbness is usually temporary and usually resolves in six months, but may be permanent in some people. Another possible adverse consequence is the formation of a widened scar after the coronal type lift, which may require another surgical procedure to create a new, thinner scar. You may also experience hair loss or thinning hair in the vicinity of the scar. Brow asymmetry is common in many people and, despite all efforts, may remain after surgery.
The Plastic Surgery Group physicians are experienced forehead lift / brow lift surgeons in Montclair and Livingston, NJ, and Manhattan. Contact us for more information about this procedure.