A brow lift elevates the eyebrow into a more youthful position as well as helps to smooth out the wrinkles of the forehead. The brow lift can act as a permanent form of Botox by releasing or removing the muscles, which cause the wrinkles.
Evaluation for brow lift should involve the position and shape of the patient’s brow as well as the wrinkles present between the brows or on the forehead. The inner part of the eyebrow should sit on the bony rim, which can be felt around the eye. The outer part of the eyebrow should sit above this bony rim. Eyebrow position, however, is also determined by heredity and therefore normal anatomy varies from patient to patient. It is important when evaluating a patient for an upper eyelid lift that the eyebrows are also examined. The perception of excess upper eyelid skin could in fact be an abnormal position of the eyebrow. A patient may feel that they have excess skin of the upper eyelid, when, in fact, once the brow is lifted into a normal position, the excess eyelid skin disappears. Therefore a patient may only need a brow lift procedure to improve their brow position, which then improves their upper eyelid. Or, they may need a combination of both upper eyelid lift and brow lift to give them the best results.
A brow lift is performed through several different techniques. If only a minimal amount of lifting is needed to improve the eyebrow shape and the patient wishes to minimize scarring, an endoscopic brow lift is the best option. This requires approximately four to five 1 to 2 cm incisions in the scalp to allow for elevation of the skin and muscle of the forehead region in lifting the brows. If a more significant lift is required, the patient will need an open brow lift procedure. This consists of an incision at the hairline or back in the scalp area. Which incision to use is based on the patient’s hairline, patient’s preference, and how the patient often wears his or her hair.
With any of the brow lift techniques, treatment of the forehead and frown wrinkles can be performed at the same time. The muscles of the forehead, which raise the brow, can be cut to decrease forehead wrinkle formation. The corrugator muscles, which cause frowning, can also be removed to permanently decrease or eliminate these wrinkles.
The brow lift procedure is a 2-3 hour outpatient procedure under local anesthesia with sedation or general anesthesia, and is often performed along with either an upper eyelid lift or a facelift procedure. Drains are commonly placed and a wrap used to decrease swelling and bruising. After surgery, the patient should be driven home and should have a friend or family member with them the first night after the procedure. The patient needs to keep their head elevated and ice on the area as much as possible the first 24 hours to decrease the swelling and bruising. Drains are usually pulled the day after surgery and the sutures are removed in 7-10 days and makeup can be placed as soon as the incisions are healed.
Risks with brow lift are possible, as with any surgery. A collection of blood called a hematoma is a possible complication seen in the first 24 hours after surgery. Problems with wound healing are possible, especially in patients who smoke and therefore a more conservative lift would be required to decrease the chance of this complication. Scars will be present after the surgery, but are most commonly fine white lines that are very easily hidden. Incisions made at the hairline are placed to allow new hair to grow through the incision, helping to hide the scar. Widening of the scars can occur if tension is placed on the skin during the surgery, therefore this tension is avoided. No two sides of the face are the same before surgery and slight asymmetries after surgery are expected and normal for the procedure. When the skin is lifted from the underlying tissue, there will be numbness in the area of the skin treated with the surgery. This numbness resolves slowly with time. There is a rare risk of injury to the nerves of the forehead, which could cause muscle weakness causing asymmetry.
Realistic expectations are a very important part of the decision to undergo cosmetic surgery. It is important to remember that with any of these cosmetic procedures, results are permanent although you will continue to age. In other words, 15 years after the brow lift, a patient can expect to look younger than they would have if they had not had the brow lift, but they will have aged since the procedure.