Brow lift

Why do a brow lift?

Patients requiring a brow lift may complain of droopy or tired-looking eyes, blockage of the peripheral vision, shadows or dimming of light, eye fatigue due to weighing of the skin on the lashes, or even scratchiness from lashes being pushed against the cornea.

Many women choose to get a brow lift as they get older and lose some of the skin elasticity on their face. Decreased skin elasticity coupled with worn out collagen and muscle causes skin to droop and exaggerate wrinkles. In some cases this characteristic drooping gives the eyes a perpetual tired/sad look.

The following factors affect drooping of the upper eyelids:

-lowering of the lid margin (true ptosis)
-excess tissue between the eyebrows and eye lashes (dermatochalasis or false ptosis)

-dropping of the eyebrows (brow ptosis)

It is important to identify which problem exist because each problem is addressed with a different surgical procedure and it is important that your Facial Surgeon performs a though examination and identify the cause of the drooping eyelids.

What does the surgeon check for during the examination?

Your surgeon should check for the position of your eye brows. In men, the brow usually lies vertically at the level of the superior orbital rim, whereas in women the brow should rest above the orbital rim.
Your surgeon will also check the amount of excess eyelid skin, height of the forehead, depth and location of horizontal forehead wrinkles, thickness of the skin, shape of the hairline, and the thickness and length of the eyebrow hair.

Brow position is determined by tissue elasticity, gravitational forces, attachments to underlying tissue, and the actions of elevating and depressing muscles

A full assessment of your vision and the nerves that allows you to feel sensation over your brow and forehead will be assessed together with the assessment of the nerve that moves the muscles of your forehead and brows.

How is a Brow lift done?

There are several procedures for lifting the brow. Your surgeon should determine the procedure that is best for you following your assessment.

The endoscopic brow lift works by making tiny incisions near the hairline, inserting endoscopic instruments and separating skin and its attached fat and muscles from the forehead area of the skull. A mid-line incision and two para-midline incisions, approximately 1 cm behind the hairline and 2 cm long are used to gain access to the forehead subperiosteal space (space above the bone). Two further incisions are made in the temple to provide extra lateral lift of the brow.

Worn out or overactive muscles that pull down the brows and create frown lines, can then be weakened, and the skin and ligaments can be pulled upwards via the small incisions near the hairline. The endoscopic or minimal incision brow lift is the most commonly used, however some patients have very thick skin or deep wrinkled and a customized coronal or “open” technique may be best suited.

The open or direct brow lift works by making a broad incision along the top of the head, from ear to ear. The pattern of the incision depends on your hair pattern and is customized for your needs. The incision is kept far from the hairline and hair often grows through the scar so that it is imperceptible in the future. Skin is then carefully separated from the skull, and the top of the face is folded downwards so that problematic worn muscle can be removed. The muscles responsible for dynamic wrinkles and lines are weakened. This gives your brow lift longevity. Excess skin can then be cut out and the face can be re-sutured at the incision on the top of the head.

Image showing the sites where the incisions are placed. Red lines are for the open approach, green lines for the endoscopic approach and blue lines can also be used if skin is to be excised in the endoscopic approach

Image showing the sites where the incisions are placed. Red lines are for the open approach, green lines for the endoscopic approach and blue lines can also be used if skin is to be excised in the endoscopic approach. Green lines in the region of the temple can be used for a temporal or lateral brow lift.

 

In both the endoscopic and traditional brow lift methods, the result is a tightened, wrinkle-free skin surface with reduced droopiness of the brow. Incisions are placed so as to avoid visible scars.

The transblepharoplasty approach involves making an  incision through the eyelid crease. Frequently, there is some degree of dermatochalasis or eyelid ptosis accompanying the brow ptosis, and there is great appeal in using a single incision to lift both the lid and the brow. The lid crease incision is hidden, and scarring is a minor concern with good technique. Fixation and re-suspension of the brow can be performed with the use of the transblepharoplasty Endotine fixation system. With this technique patients may complain of prolong or persistent numbness of the area over the eyebrow and also persistent swelling of the location of the implant. The implant usually dissolves in 6-12 months

Endotine Fixation Device

 

 

A temporal or lateral brow lift ( outer aspect of the brow) can be performed as part of a combined approach using one of the techniques described above. The incision can be placed in the temporal hairline to avoid visible scars. It is important that your surgeon is familiar with the anatomy of this part of the face to avoid damage to important nerves running in this area.

Your Facial Surgeon will ask to see pictures of your brow position when you were in your twenties or early thirties because often a brow lift does not actually require the brows to be lifted very much and it is more of a forehead smoothing and brow shaping technique. The over-pulled or “too tight” look is avoided at all costs and the aim is to achieve a natural look.

 

What to expect after a brow lift?

Your surgeon will place a pressure head dressing and sometimes a surgical drain that will be removed after 24 hours. There will be swelling, bruising of the forehead and around the eyes. This can last for up to 3 weeks.

You will be advised to keep the wounds dry until the stitches are removed and will be given antibiotic ointment to use on the wounds. The stiches are usually removed after 7 days.

The risk of having a brow lift includes pain, infection, swelling, bruising, numbness of the scalp, forehead, eyebrow region, weakness of the forehead, headaches and hair loss at the site of the incision. Also, with time the brow will undergo the natural aging process.

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