Register Today!


Find Surgeon by State or City
State
City


Featured Surgeons


Dr. Chang Soo Kim
11 Maple Ave
Greenwich
Connecticut 6830


Newly Added Surgeons


Dr. Bianca Chin
1329 Cherryway Dr #200
Columbus
Ohio 43230
Dr. Ergun Kocak
1329 Cherryway Dr #200
Columbus
Ohio 43230
Dr. J. Kevin Duplechain
1103 Kaliste Saloom Road #300
Lafayette
Louisiana 70508


Browlift



Overview

Another name for brow lift is forehead lift. Aging affects the entire face. Some areas, such as around the eyes, have more obvious aging changes. The eyes appear to be the most affected because they have so much expression and, therefore, patients often come in requesting eyelid cosmetic surgery. Quite often, however, the more significant problem lies within the eyebrows. As we age, the eyebrows descend; especially the outer part or part closer to the temple which falls much more than the part of eyebrows closer to the nose. Take a look at most older people and you will see this to be true.

Most people do not realize it, but the descent of the eyebrow is largely responsible for what we think of as an old looking face. In the youthful face, especially in women, the eyebrow is located above the bony rim of the eye socket. With aging, the eyebrow falls to the level of the rim and often below the rim becoming almost part of the upper eyelid. Even more dramatic is the fact that the outer eyebrow falls much more than the inner eyebrow giving the typical appearance of aging. You can try this on yourself. Stand in front of a mirror. Take your fingers and elevate the outer part of your eyebrow. Most likely, this will create a more elegant and youthful look. It also tends to help the aging problems of the upper eyelid. This is what a properly performed brow lift will do.

The effects of aging cannot be completely reversed with a brow lift because there are other components involved such as changes in both the subcutaneous fat and muscles. But as you can see by simply elevating the outer part of your eyebrow much can be done to re-create the youthful look.

There are many different types of brow lifts. It is important as a plastic surgeon to have expertise in all of the different brow lifts so that the doctor can, without bias, choose the one that is best for you.

The Three types of brow lifts that many doctors find most effective are

    1) The minimal incision brow lift.

    2) The endoscopic brow lift

    3) the brow lift through an upper eyelid incision. There is a fourth type of brow lift called the open brow lift that which is performed occasionally but, usually, only when there is a significant amount of loose skin within the upper forehead.

The minimal incision brow lift is a very effective way to obtain the desired elevation of the lateral brow and “crow's feet” area with only a small incision within the hairline or just above the hairline.

The endoscopic brow lift is almost the exact same as the minimal incision brow lift except, of course, with the addition of the endoscope. The endoscope helps visualize the dissection and what needs to be lifted. The incisions are within the scalp.

The third type, brow lift through an upper eyelid, is frequently performed at the same time as an upper blepharoplasty. This is a great way to add a brow lift when you are already having cosmetic surgery on the upper eyelid. Some doctors elevate not only the brow but also the fat and muscles. Fat and muscle descent contributes to the appearance of the aging eyebrow just as much, if not more, as lax skin. It must be pointed out, however, that this type of brow lift does not elevate as much as the other two but it is an effective way to elevate the brow without having to make another incision.

The fourth and final brow lift mentioned above is the open technique. This is a very effective way to perform a brow lift but it involves a very long incision usually within the scalp but may be done at the hairline. It is useful when there is a significant amount of loose skin within the forehead and the eyebrows have descended a great deal. Most doctors do not use this type of brow lift often as he they are usually able to accomplish the desired brow elevation using much smaller incisions.

Often, a brow lift is performed in conjunction with other facial cosmetic procedures such as eyelid surgery and facelift. The reason for this is that facial aging does not affect just one part but the entire face.

Benefits

Eyebrows that have descended makes one look old and tired. The eyebrows of youth are positioned above the rim of the eye socket with the outer part of the eyebrow higher than the part toward the nose. You may benefit from a brow lift if you have any of the following problems.

  • An additional benefit to brow lifting is that it significantly helps diminish the wrinkles in the crow's feet area.

Are you a good candidate?

Descent of the eyebrows is a universal part of aging. It becomes evident in the late 30s and early 40s and is progressive. Just because you have eyebrow descent does not necessarily mean that a brow lift would be beneficial to you. The best way to determine if a brow lift would be beneficial is to stand in front of a mirror, place your fingers about an inch above the outer portion of your eyebrows on both sides and elevate the outside part of your eyebrows. Does this obtain the look that you want? If it does, you most likely would benefit from a brow lift. You will most likely be a good candidate if you have any of the following:

  • Your eyebrows have descended and are at or below the eye socket rim.
  • Your eyebrows appear too close to your eyelids.
  • You strain and wrinkle your forehead to elevate your eyebrows.
  • The outer part of your eyebrow is lower or at the same level as the portion of the eyebrow closer to the nose.
  • Your upper eyelids and eyebrow area appear tired.

Possible complications

The most common complication across the nation is inadequate elevation of the eyebrow. Other possible complications, unique to brow lifting, are nerve injury to the nerve that elevates the eyebrow, asymmetry between the two brows, and hair loss around the incision.

Do's and Don'ts prior to surgery

    Medications. Certain medications thin your blood and should not be taken within 3 weeks of surgery. The most notable is aspirin and aspirin containing products. Vitamin E and many herbal products also thin the blood and should not be used within 3 weeks of surgery. Your doctor will go over this more thoroughly prior to the procedure.

    Sleep. It is important to get a good night's rest prior to the procedure. If you think this may be a problem, please, do not hesitate to ask your doctor for something to help you sleep.

    Smoking. It is important to not smoke within 3 weeks before and after surgery. Smoking has a profound effect on reducing wound healing capabilities. It significantly increases the likelihood for infection, wound healing problems, and scar formation. It also affects your airway and, therefore, makes anesthesia much more difficult.

    Eating. Do not eat within 8 hours of surgery and do not drink within 6 hours of surgery. Please discuss all medications with your plastic surgeon and the anesthesiologist.

    Washing. Wash your hair thoroughly the morning before surgery and be sure to use a conditioner so that your hair is manageable. Style your hair very simply and do not use hair spray or put anything else into your hair. It is helpful if you merely comb your hair back. Wash your face as well but do not apply any makeup.

    Arrival. It is best to arrive on time to make sure everything goes smoothly. Please be sure to have someone else drive you home.

    State of mind. Remember, this should be a happy and exciting time. A certain amount of nervousness is normal but you must not be overly concerned. Excessive worrying can actually be detrimental. If you are a very anxious person you should discuss this with your doctor prior to surgery so that something can be prescribed to make sure you remain calm.

Anesthesia

The anesthesiologist will discuss with you what type of anesthesia is best for you prior to the procedure. He/she will take into consideration your medical history, the procedure, and your personal wishes.

Normally, most doctors perform brow-lifting under the general anesthesia. It is possible, however, to perform the minimal incision brow lift under local anesthesia with or without sedation.

After the procedure

The procedure itself will take about 2 hours.

Immediately. Right after the operation you will be watched for 1 or 2 hours and encouraged to walk around. You will be given as much pain medication as necessary both immediately after the operation and for the next 4 to 5 days. You will have a dressing around your head and ice packs above your eyes to decrease swelling. You must sit or lie with your head elevated to decrease swelling.

That evening. It is recommended that you take it easy. You can walk around, eat, but not too much more. You should take as much pain medication as necessary and try to go to sleep early. Remember to sleep with at least 3 pillows to keep your head elevated so swelling is reduced. Do not move your forehead muscles for the first 2 weeks after the procedure.

First 48 hours. The next day you should remove your dressings and take a cool shower. You may have dried blood in your hair. Gently wash your hair with a shampoo with a conditioner. When you get out of the shower simply dab dry, comb your hair gently back, and sit most of the day to keep your head elevated. Your are encouraged to walk around but do not do anything that requires bending over or lowering your head in any way. You can expect to see bruising and swelling around the eyes.

First week. At about day 3 you can move around normally. Continue to keep your head elevated until at least day 7. Your first postoperative visit with your plastic surgeon will be approximately after 1 week. The majority of the bruising and swelling will go away in about 2 to 3 weeks.

Beyond. Swelling will not completely resolve for about 6 months but, as mentioned above, the majority of it will be gone by 3 weeks.

Recovery time

Some people with sedentary jobs go back to work in less than a week. If your job, however, requires strenuous activity it may take as long as 4 weeks to return to work. Most people return to work after about 10 days. You must understand, however, that the bruising may not be gone for up to 2 weeks.

Consultation

We have outlined below what you can expect from your brow lift consultation. Read carefully, as there are many suggestions that will save you time, clear up questions, and help you convey to your plastic surgeon what it is you want to accomplish.

Health History

All cosmetic surgery consultations begin with a thorough health history. This is especially true if general anesthesia is being used but also applies to local anesthesia. Prior to meeting with the plastic surgeon you will be given a health history questionnaire. There are five areas of your health you will be asked about. Be sure to answer it with detail so that your surgery and anesthesia can be optimized for you.

  • General Health

General health problems are important to discuss so that your surgery is as safe as possible. Be sure to mention any chronic illness. Of particular concern are high blood pressure, diabetes, heart problems, liver and kidney disease, stroke, cancer, bleeding problems, and wound healing problems.

What will the plastic surgeon do if I have medical problems?

In short, he/she will make sure your health is optimized as much as possible to ensure your safety. This may mean referring you to your private physician.

If you have a health problem or are over 50 years of age you can often save yourself time by getting a letter from your private physician prior to your cosmetic consultation stating what the problem is, how it is being treated, and whether or not you are able to tolerate general anesthesia safely.

If you are seeing any specialist (cardiologist, kidney doctor, psychiatrist, etc. ) be sure to bring a letter from them stating you are able to tolerate surgery.

If you are not able to tolerate general anesthesia it may be possible for your procedure to be done under local anesthesia. This must be discussed with your plastic surgeon.

  • Past Surgical History

On your questionnaire you will be asked about previous surgeries. Be sure to identify any problems you may have had with anesthesia. Of particular concern are previous cosmetic surgeries especially if you do not like the result and are interested in revision.

  • Medications

Be sure to list all medications including aspirin and over-the-counter medications. These are important as they may increase bleeding and affect your surgery. It is extremely important to stop taking aspirin and aspirin containing products at least 10 days before surgery. Tylenol is a good alternative. Here is a partial list of aspirin containing products and other products to be avoided prior to surgery.

  • Allergies to Medications

Information about medications that cause allergies is very important so that these medications can be avoided. Of particular importance is the reaction you had, especially if you had trouble breathing. Be sure to include this information! Nausea is not an allergy but it is important to mention as well.

  • Smoking, Drinking and Drug Use

These there will certainly affect your surgery and MUST be mentioned so that your surgery can be optimized. Smoking causes a profound decrease in wound healing and will lead to worse scarring and a less favorable result. With large procedures such as a face lift, neck lift, tummy tuck, and breast lift smoking must be stopped at least 2-3 weeks before and after surgery. Otherwise, the results could be disastrous leading to non-healing wounds, poor scarring, and/or infection. With smaller procedures such as eyelid surgery, nose surgery, breast augmentation, and liposuction smoking will hurt the overall result but this may or may not be noticeable. In this case smoking cessation is strongly advised but is not mandatory.

What Do You Want To Change?

It is important that you have a clear idea of what you want changed when you go for a consultation. The least favorite thing a plastic surgeon wants to hear is: What do you think I need done?

Look in a mirror and identify what bothers you. Be specific. It is helpful to break up the forehead region into 4 parts. 1) Forehead 2) Lateral (outside) Brow 3) Medial (inside) Brow 4) Upper Eyelid. Evaluate each one of these areas individually as this is what the plastic surgeon will do in his/her exam.

Common complaints

  • Forehead: Wrinkles (especially with animation)
  • Lateral Brow: Droopy
  • Medial Brow: Droopy, wrinkles between the brows
  • Upper Eyelid: Droopy, excess skin, excess fat

Ideal Brow Shape

  • Forehead
    • Smooth; few wrinkles with animation and no wrinkles at rest
  • Lateral Brow
    • The lateral brow should be 2-3 mm higher than the medial brow in women and at least the same height or higher in men.
    • There should be no crow's feet at rest and only a minimal amount with animation.
  • Medial Brow
    • Should be higher than the bony rim that surrounds the eye.
    • The bridge of the nose should be smooth.

Physical Exam

The key to the face physical exam is to determine exactly what is causing the problem. Below is a typical sequence that an experienced plastic surgeon uses to evaluate the brow and what can be done to correct problems.

  • Forehead

Wrinkles of the forehead are caused by over-active frontalis muscles. Often, these are best treated with Botox® injections. The most significant drawback is that these injections must be repeated. Click here to get more information on Botox®. A brow lift can diminish these wrinkles if the plastic surgeon removes part of the frontalis muscle but this is not predicable.

  • Lateral Brow

During your consultation, your plastic surgeon will evaluate the position of your lateral brow in relation to your medial brow and to the bony rim below. He/she will then elevate your lateral brow with his/her finger to determine where it should be repositioned. You can do this to yourself at home in the mirror. Often, elevating the lateral brow gives a more youthful appearance to the brow and eye region. Also, this elevation tightens some of the wrinkled, excess skin within the crow's feet area.

  • Medial Brow

The medial brow should be at or above the level of the bony rim below. Elevating the medial brow is not nearly as common as the lateral brow because it is less likely to descend. Elevating the lateral brow creates an elegant, youthful appearance. Elevating only the medial brow is rare as it can cause an unnatural, surprised look.

Wrinkles between the 2 brows can be treated during a brow lift or an upper blepharoplasty by removing the muscles that cause them. Treatment in this fashion is permanent. Sometimes, with this technique, it is necessary to fill the void where the muscle was removed by replacing it with fat transplantation.

  • Upper Eyelid

When your plastic surgeon elevates your brow with his fingers, he/she will also determine its effect on the upper eyelid. If, by elevating the brow, the desired result is obtained, then it is clear that only a brow lift is necessary. If, however, excess skin and/or fat persists in the upper eyelid, then an upper blepharoplasty is also required. Click here for further information on Upper Eyelid Surgery

Procedures

There are 3 common ways to perform a brow lift.

  • Endoscopic Brow Lift

An endoscopic brow lift has the advantage of leaving only small scars in the hair bearing scalp. Usually 3 or 5 of these short incisions are used to elevate the brow. Another advantage is that the muscles that cause wrinkles between the 2 brows can be removed with this technique. This can significantly improve these wrinkles permanently. Endoscopic brow lifting first became popular in the early 1990's. Some plastic surgeons feel that some skin excision is necessary to maintain a brow lift in its elevated position, therefore, they have switched back to the short scar technique.

  • Short Scar Brow Lift

The short scar technique is the most common. It utilizes 2 incisions on both sides of the scalp. Each incision is 1-2 inches in length and is placed either at the hairline or within the hair-bearing scalp. The hairline incision has the advantage of lowering the hairline slightly. The incision within the scalp has the advantage of a hidden scar. It must be pointed out, however, that the hairline incision becomes almost undetectable.

  • Coronal Brow Lift

The most aggressive brow lift is the coronal incision. The incision extend all the way across the scalp from one side to the other. This is the most effective way of correcting severe brow sag especially within the medial brow. Effective removal of wrinkle causing muscles can be performed. The obvious downside is the long incision. Another complication is the loss of sensation to the scalp posterior to the incision. This is why this technique is done only when there is severe brow descent.

All 3 methods involve repositioning of the brow superiorly. As with all of plastic surgery procedures, excellent results can be achieved with each method. The results depend on the experience and technical abilities of the plastic surgeon not the technique used.