Face Procedures

Brow Lift

Also known as forehead lift or browplasty

A brow lift or forehead lift reverses the effects of gravity and tightens the soft tissues of the forehead to restore a more youthful contour to your forehead skin, upper eyelids and eyebrows. There are various brow-lift methods, which involve different length incisions in different locations and, sometimes, an endoscope. A youthful brow at rest is positioned above the orbital rim, with a gradual arch laterally, and the lateral end or ‘tail’ of the brow located higher than the medial end. As one ages, it is common for the brow to assume a flat or horizontal position. If a sagging brow inhibits your facial expression, a brow lift is a time-tested method for rejuvenating the upper third of your face. Every year, thousands of people undergo successful brow-lift surgery and are pleased with the results.

When to Consider a Brow Lift

• Sagging or low eyebrow position creates a tired, sad or grumpy appearance
• You have deep horizontal creases across the forehead
• You have frown lines or furrows between the eyebrows or across the top of your nose
• You have excess skin or fatty tissue hanging over your eyes

Considerations

Pros

• Repositions a low or sagging brow that hangs over the upper eyelid
• Raises the eyebrows to a more alert and youthful position
• Makes you look happier, friendlier and more approachable

Cons

• Only a highly experienced board-certified plastic surgeon can determine if this procedure will achieve your goals.
• Choice of brow-lift technique is very important to outcome, so this procedure is very clinician dependent.
• You may also need blepharoplasty (eyelid surgery), as a forehead lift does not improve baggy eyelids or crow’s feet.

These are the top three pros and cons to weigh when considering a brow lift. If you want to focus on what is unique to you, please consult with your aesthetic plastic surgeon.

Are you a good candidate for a brow lift?

The following are some common reasons why you may want to consider a brow lift:

• The outside of your brow sags, resulting in a sad expression.
• The central portion of your brow hangs down, making you look angry
• You have frown lines between your eyes.
• If you are a female and you are unable to apply makeup on the upper eyelid, because the surface area has been obscured by drooping tissues as you have aged.
• If you gently lift the skin above your eyebrow into a pleasing position and it eliminates most of the excess skin in your upper eyelid, a brow lift may be right for you.

Rely on an evaluation from a board-certified plastic surgeon to find out if you would benefit from a brow lift, blepharoplasty, or both procedures. If you are in good general health, have a positive attitude and realistic expectations, you are most likely a good candidate for brow lift and eyelid surgery procedures.

1. Brow lift raises drooping upper eyelids, eyebrows and smooths forehead creases and frown lines.
2. After surgery, your eyebrows will be elevated and forehead will be smooth, resulting in a refreshed appearance.

Detailed Procedural Info

How is a brow lift procedure performed?

Brow-lift procedures have evolved from open techniques to more complex short incision and endoscopic techniques. A brow lift usually involves incisions in the hair-bearing scalp, but sometimes incisions are made in the forehead and/or the upper eyelids.

• Open brow lift.Your surgeon makes a long incision across the forehead, either around the hairline or in one of the creases of the forehead, and lifts the skin away from the underlying tissues. The surgeon then loosens muscles and removes fat. He or she removes any excess skin, pulls the remaining skin down, and stitches the brow into its new position. Other names sometimes used to describe open brow lift include classic, coronal or trichophytic brow lift.
• Endoscopic brow lift.Your surgeon will insert an endoscope (a long, thin tube with a light at the end attached to a video camera) through several tiny incisions in the scalp. This allows your surgeon to see and work on the various internal structures of the forehead. The endoscopic technique requires very minimal incisions, but it may not be equally beneficial for all patients.
• Limited incision technique.This hybrid technique of both procedures is non-endoscopic with limited incisions. It uses a small portion of the ends of the coronal technique incision to elevate the outside part of the eyebrows under direct vision without an endoscope. The resulting scars are hidden in the temporal hairline, even in balding men who have little temporal hair remaining. While this procedure does not address the center area of the brow, it can reduce wrinkles at the corners of the eyes, commonly referred to as ‘crow’s feet.’ Since many forehead-lift procedures are performed with an upper blepharoplasty, the upper eyelid incisions are used to complete the forehead-lift procedure by treating the ‘frown’ lines between the eyebrows and raising the inside part of the eyebrows.

The type of brow lift you undergo will be based on your facial features and aesthetic preferences. The goal of your aesthetic plastic surgeon and the entire staff is to help you achieve the most beautiful and natural-looking results, as well as to make your surgical experience as easy and comfortable as possible.

What are my options?

Excess eyelid skin, droopy upper eyelids, and droopy eyebrows commonly occur in the same patient. It is not possible to achieve a good aesthetic and functional result unless all three problems are addressed. Your plastic surgeon will assess your problem, considering your hairline and hair style preferences, and make a recommendation that will yield the least scarring and the best cosmetic results. Here are some general guidelines:

• If you have mild to moderate brow droop and horizontal wrinkles, an endoscopic lift may be a good choice.
• If you have advanced brow droop with deep wrinkles, a coronal forehead lift may be most appropriate.
• If you have a high forehead, to avoid raising your hairline further, you may undergo a subcutaneous lift. In this procedure, your incision is near the hairline, leaving visible scars that can be hidden with hair.

What will my brow lift incisions and scars be like?

The brow-lift incisions will be based on the technique your surgeon uses and will result in scars. The incisions are generally placed so they will be well concealed, frequently within or at the hairline, or within a deep forehead crease.

Open (coronal) technique. The incision is across the top of the scalp, beginning above the ears and hidden within the hair.

Endoscopic forehead lift. Your incisions may include three short incisions along the top of the scalp and a temple incision on each side. These incisions will be totally hidden within the hair.

Limited incision technique. The incisions will be hidden in the temporal hairline (temples). If your forehead lift is done in conjunction with an upper blepharoplasty, upper eyelid incisions will be used to complete the forehead lift by treating ‘frown’ lines between the eyebrows and raising the inside part of the eyebrows.

1. The endoscopic brow lift uses several small incisions within the hairline. Incisions and placement vary.
2. Once incisions are made, the eyebrows are raised and repositioned along with the underlying muscle (as needed).

Selecting a Surgeon

Select a surgeon you can trust

It’s important to choose your surgeon based on:

• Education, training, and certification
• Experience with brow lifts
• Your comfort level with him or her

After finding a board-certified plastic surgeon in your area who is experienced in performing brow lifts, you will need to make an office appointment to set up your consultation. Generally, because of the in-depth nature of the consultation, there is a cost associated with the initial visit.

Your initial consultation appointment

During your initial consultation, you will have the opportunity to discuss what you want to achieve. Your surgeon will evaluate you as a candidate for brow lift and clarify what a brow lift can do for you. Once the surgeon understands your goals he or she may suggest additional or related procedures. It is important to be completely honest during the consultation. Also, bring pictures of yourself at an earlier age; they may serve as a good point of reference for discussing your goals. It’s a good idea to be fully prepared to answer these questions:

• Do you have any medical conditions or drug allergies? Are you being treated for any medical conditions?
• Have you had any previous surgeries?
• What are your current medications and vitamin and herbal supplements?
• What is your current use of alcohol, tobacco, and recreational drugs?
• What is your history with any noninvasive cosmetic procedures?
• What outcome do you expect from the surgery? What is your chief motivation in undergoing brow-lift surgery?

Your surgeon may also:

• Ask you to look in a mirror and point out exactly what you would like to see improved.
• Take photos for your medical record, measure your face, and use computer imaging to show you the improvements you can expect
• Evaluate your health status, including pre-existing health conditions or risk factors
• Evaluate the elasticity of your skin
• Discuss your options and recommend a course of treatment
• Discuss likely outcomes, including risks or potential complications
• Discuss the type of anesthesia that will be used

Your treatment plan

Based on your goals and physical characteristics, and the surgeon’s years of training and experience, your surgeon will share recommendations and information with you, including:

• An approach to your surgery, including the type of procedure or combination of procedures
• The outcomes that you can anticipate
• Your financial investment for the procedures
• Associated risks and complications
• Options for anesthesia and surgery location
• What is needed to prepare for the surgery
• What you can expect to experience after surgery
• Share before-and-after photos of cases similar to yours and answer any questions.

Questions to ask your aesthetic plastic surgeon

For a general list of questions to ask your surgeon about his background, to find out about plastic surgery safety, and to plan your procedure. We developed these questions to help you:

• Make the most informed and intelligent decisions about your procedure
• Confirm that you have the right surgeon for your procedure
• Make your initial consultation as rewarding as possible
• Understand your options, potential outcomes, and risks

It is important for you to take an active role in your surgery, so please use this list of questions as a starting point for your initial consultation.

• Am I a good candidate for a brow lift?
• Are the results I am seeking reasonable and realistic?
• Do you have before-and-after photos I can look at for this procedure?
• Will my scars be visible?
• What kind of anesthesia do you recommend for me?
• What will be the costs associated with my brow lift?
• What will you expect of me to get the best results?
• What kind of recovery period can I expect, and when can I resume normal activities?
• What are the risks and complications associated with my procedure?
• How are complications handled?
• What are my options if the cosmetic outcome of my brow lift does not meet the goals we agreed on?

Preparing for Your Procedure

How do I prepare for a brow lift procedure?

Your surgeon will provide thorough preoperative instructions, answer any questions you may have, take a detailed medical history, and perform a physical exam to determine your fitness for surgery. Here are some of the preoperative instructions you can expect:

• If you smoke, your surgeon will ask you to stop at least six weeks before your surgery. Smoking greatly increases the risk of complications and slows the healing process.
• You may have to limit alcohol consumption and avoid certain medications.
• If you regularly take aspirin or another anti-inflammatory drug, your surgeon will ask you to stop taking these for a period before surgery. These drugs can cause increased bleeding.
• Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery.
• If your hair is short, you may want to grow it out to cover any scars.
• Make arrangements to be driven to and from surgery on the day of your procedure.
• You should have someone to take care of you on your first night home and, if possible, the first two days following surgery.
• Fill all prescriptions before surgery.
• Set up your recovery area ahead of time. You should have easy access to fluids, prepared meals, pillows to elevate your head, and reading materials and entertainment.
• Prepare ice packs. Frozen vegetables work well to reduce postoperative swelling.

What can I expect on the day of brow-lift surgery?

A brow lift may be performed in a surgeon’s office-based facility, an outpatient surgical center, or a hospital, and can take one to three hours to complete.

• Medications will be administered for your comfort during the surgical procedure.
• Local anesthesia combined with sedation is commonly used during brow-lift surgery, though general anesthesia can be used instead.
• For your safety during the surgery, various monitors will check your heart, blood pressure, pulse, and the amount of oxygen circulating in your blood.
• An anesthesiologist or nurse anesthetist will be present to administer sedatives (or general anesthetic) and assist in monitoring.
• Your plastic surgeon will follow the surgical plan discussed with you before your operation. Once surgery has begun, the surgeon may decide to combine various techniques or change a technique to ensure the best result. It is important that you feel comfortable and trust your doctor to make these decisions.
• Sections of hair will be held away from the surgery area.
• After removing excess tissue, skin, and muscle, your surgeon will close the incision with stitches or staples. Your hair and face will be washed so the scalp skin does not get irritated.
• The treated area will be wrapped with a sterile padding and an elastic bandage to prevent bleeding and swelling (edema). You will have sutures and a dressing on your forehead for the first few days after surgery. After surgery, you will be taken into a recovery area where you will continue to be closely monitored.

You can control temporary discomfort in the surgical site with medication. You may choose to go home on the day of surgery or spend the night with an office consultant or nurse, unless you and your plastic surgeon have made other plans for your immediate postoperative recovery. Under no circumstance will you be permitted to go home alone.

Aftercare and Recovery

Your surgeon will discuss how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will receive detailed instructions about your postsurgical care, including information about:

• Incision care
• Normal symptoms you will experience
• Any potential signs of complications

It is vitally important that you follow all patient care instructions provided by your surgeon, and that you realize that the amount of time it takes for recovery varies greatly among individuals.

Immediately after your brow lift

• Your surgeon may suggest icing or cold packs around the eyes for forty-eight hours to reduce the swelling.
• It is best to sleep with your back and head elevated for approximately five to seven days.
• Your surgeon will likely ask you to come back to his office a day or two after surgery so he or she can evaluate your healing.
• Pain is typically not a significant problem in brow lifts. There is, however, some discomfort and tightness from ear to ear across the top of the head and brow. Most patients describe their forehead as feeling tight and somewhat numb the night of surgery. You will be provided with pain medications should you need them.
• Drains are usually not needed in the brow area when doing a brow lift.
• Temporary bruising, swelling, and numbness are common the first night after surgery. Maximum swelling occurs forty-eight to seventy-two hours post-surgery and begins to subside on the fourth or fifth postoperative day.
• You may need to go to the bathroom frequently because of the intravenous fluids you were given during your surgery. Drink plenty of fluids to keep up with the fluid loss. As your body begins to balance itself, it will rid itself of this extra ‘water weight’ and return to normal.
• Bruising from a brow lift appears less in the brow than in neighboring areas. As a result, any bleeding usually collects below the eyelids and bruises the lower lids, even if the lower lids are not operated on. Bruising usually peaks on the third to fifth day and resolves over two to three weeks.
• Showering and bathing are permitted the next day after surgery. Use hair conditioner to help wash and clean hair that became matted or knotted during surgery. Be cautious when applying hot water, hair dryers, and combs; your scalp will be numb, so they may damage your skin and/or hair.

Recovery time frame following a brow lift

• Your sutures or staples will be removed approximately one week after surgery.
• During the first week of recovery, you should move and be mildly active, including going for walks to aid circulation in your lower extremities. However, do not attempt heavy lifting or strenuous activity.
• You can resume driving when you are able to drive as well as you did before surgery. You need to be able to brake, respond, and turn quickly. When these conditions are met, you may resume driving, typically in the second or third week after surgery.
• You may be able to return to work within a week and to full activity within a few weeks, but you must avoid heavy lifting or straining during this time.
• Sensation in your scalp may be temporarily reduced. The feeling will begin to return over the first few weeks after surgery and your scalp will begin to feel ‘itchy’ as the nerves reawaken. Total numbness behind the incision in an open brow lift will usually persist for nine to twelve months post-surgery, sometimes longer in rare instances.

One month following surgery

• You should have returned to your normal rhythm at work by this time, depending on the amount of physical exertion required to perform your duties.
• Begin exercise and workout routines. Avoid any activity that causes discomfort and/or pain until you are further along in your recovery process. When you return to the activity, start at half speed and increase to your normal routine as long as you do not feel any pain during and/or the day after your workout.

How Long Will the Results Last?

Usually, you can expect the final result from surgery to be evident after six months. By then, the scalp and hairline incisions will have healed completely and you should be enjoying your more youthful appearance. Gravity will take its toll as aging continues, but portions of the brow lift, especially wrinkle lines in the brow and the frown line area, should never be as severe again and may return only mildly over the years. Life-long sun protection and a healthy lifestyle will help to maintain and extend the results of your more youthful appearance.

Maintain a relationship with your aesthetic plastic surgeon
For safety, as well as the most beautiful and healthy outcome, it is important to return to your plastic surgeon’s office for follow-up evaluation at prescribed times and whenever you have any questions about your brow-lift healing and results.

Associated Costs

The cost of a brow lift varies from surgeon to surgeon, from one geographic area to another, and with the technique that is performed.

Because a brow lift is elective surgery, insurance does not cover these costs. Many surgeons offer patient financing plans to make the procedure more affordable.

Choose your surgeon based on quality, training, and experience—not cost.

Limitations and Risks

Fortunately, significant complications from brow-lift surgery are infrequent. This surgery is usually performed without any major problems.

Risks and potential complications of surgery is should be discussed during your consultation. The risks in most surgeries are similar. Some of the potential complications of all surgeries are:

• Adverse reaction to anesthesia
• Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
• Infection and bleeding
• Changes in sensation
• Scarring
• Allergic reactions
• Damage to underlying structures
• Unsatisfactory results that may necessitate additional procedures.

You can help minimize certain risks by following the advice and instructions of your board-certified plastic surgeon, both before and after your brow-lift surgery.

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