Increasing lining of the forehead, furrows between the eyebrows and a low and drooping appearance of the brows gives an aging appearance to the face. Changes in the position or shape of the eyebrows create different facial expressions. For example, low and sagging eyebrows gives the expression of being sad, tired, or depressed. Excess skin of the upper eyelids causing a tired and aging appearance may be caused by low eyebrow position. Frown lines or furrows between the eyebrows creates an angry or upset look. The only difference in the three faces shown below is the shape and position of the brows. These brow changes alone communicate different emotions.
Brow lift – Forehead Lift
A Brow Lift or Forehead Lift is a surgical procedure that will correct or improve unwanted changes of the brows.
How is a Brow Lift or Forehead Lift Performed?
A Brow Lift is an individualized procedure. There are several methods that have evolved over the years. The type of surgery performed is in large part dependent upon your own dynamic facial features:
- Position of the brows
- Shape of the eyebrows
- Height of the forehead
- Position of the hairline
- Thickness of the hair or hair loss
- Mobility of the forehead skin, including thickness and elasticity
- Lining of the forehead
- Furrows or creasing between the eyebrows
- Excess skin or drooping of the upper eyelids
A decision about what type of surgery will be performed ultimately will be determined by your goals and understanding the benefits, limitations and realistic expectation of the different surgical options. There are advantages as well as disadvantages of each of these procedures. All of these procedures have evolved with the goal of not to have a surprised or expressionless appearance.
Coronal Brow Lift
This was the original technique developed to perform a brow or forehead lift. An incision is made in the hair behind the natural hairline of the forehead and temples. The skin and deep layers forehead are undermined and elevated to the eyebrows inferiorly. Muscles that are the cause of the lining or furrowing are selectively removed. Care is taken to preserve active movement of the lateral brows. The forehead is lifted superiorly to reposition the brows. The excess scalp is removed and the incision closed.
The major advantage of this procedure is that the incision is well concealed in the hair-bearing scalp and that the results are reliable and long lasting. This technique raises the hairline. This may be a problem for those with an existing high forehead. If this is the case the incision can be made within the hairline instead of behind the hairline. Hair loss and decreased sensation are possible complications that may occur. Men with hair loss or baldness would need alternative procedures.
Lateral-Temporal Brow Lift
For those who prefer or cannot have an incision across the entire scalp as done with the Coronal Brow Lift, the Lateral Temporal Brow Lift may be an alternative. This procedure is performed by making a 1-2 inch incision in the temporal hairline. The advantage is that there are only small incisions in both temple scalp areas. This procedure is performed for elevation of the lateral brow and forehead. It will not correct mid forehead lining or furrowing and creasing between the eyebrows. To correct the furrowing between the eyebrows a Transpalpebral Excision of Corrugator and Procerus Muscles may be done.
Lateral-Temporal Brow Lift. Transpalpebral Excision of Corrugator and Procerus Muscles
This procedure is performed by making an incision in the natural skin crease and fold of the upper eyelid. This operation is done to treat the creasing and lining between the eyebrows. The Corrugator and Procerus muscles that cause frowning are modified or removed. Although this procedure can be done alone, it is often done in conjunction with an Upper Lid Blepharoplasty and or with the Lateral-Temporal Brow Lift.
Endoscopic Brow Lift
Several small incisions are placed in the scalp behind the hairline. An endoscope, that is surgical video device connected to a camera and video monitor, is placed through these incisions. The dissection and elevation of the forehead and selective muscle removal is the same as the Coronal Brow Lift except that it is done by viewing this on a video monitor. Instead of removing portions of the scalp, an absorbable surgical tack device is secured to the bone of the skull and the scalp is secured to this to maintain the fixation of the elevated forehead and brow. The Endoscopic Brow Lift allows performance of the same things that can be done with the open Coronal Brow Lift but through very small scalp incisions. The advantage is less chance of sensory loss. The disadvantage of this procedure is that the longevity of this lift does not appear to be as long as the Coronal Brow Lift.
What Is The Recovery After Brow Lift Surgery
Brow Lift surgery is done as an outpatient. At home, it is important to keep the head elevated and avoid any physical activity for two-three weeks. Brow Lift surgery is not greatly painful. You will, however, be provided with adequate pain medication. Initially, a wrap and dressing are placed over the forehead to decrease bruising and swelling. The wrap and dressing are removed in 24-48 hours. At this time the scalp is showered using a surgical skin cleanser. Ice compresses are applied to the forehead and eyes intermittently to reduce swelling.
Most patients can return to work in 5-10 days. Staples in the scalp are usually removed in 7 days.
Since healing is a progressive process, depending upon your own health, the final result may be seen within the few weeks to a few months.