FAQ’s – Forehead Lift (Browlift)
Browlifts can rejuvenate drooping brows and lined foreheads, helping you to look less angry, sad or tired. Using either traditional “open” or minimally invasive (endoscopic) methods, browlifts involve the removal or alteration of the muscles above the eyes to smooth lines and raise the eyebrows for a more youthful appearance. This procedure is often combined with others such as blepharoplasty (eyelid surgery) and facelifts to improve the look of the eyes and other areas of the face.
- Am I a candidate for a browlift?
- How is a browlift performed?
- What is the recovery from a browlift like?
Browlifts are typically performed on patients aged 40-70. Browlifts counteract the effects of aging for anyone with lined or inelastic skin on the forehead – whether it’s caused by muscle activity or inherited conditions. The browlift procedure is usually performed in an office-based facility or surgery center under local anesthesia and sedation or general anesthesia.
If you aren’t sure whether you want a browlift, try standing in front of a mirror and placing the palms of your hands to the sides of your eyes above the eyebrows. Then pull the skin back from the eyes, raising the forehead. This is approximately how the procedure will make you look. There are several issues to consider with a browlift. The first is the position of the medial (inner), central (middle) and lateral (outer) portions of the brow. If you raise the medial and central portions too high, you may look like you are asking a question. One of the signs of a very aesthetically pleasing female brow is a high lateral arch, sometimes higher than the central and medial portions. The other issue is distinguishing brow skin from upper eyelid skin. Upper eyelid skin is very thin. Brow skin is thick. By brow skin, I am not referring to the hair (eyebrow) bearing skin, but rather, the thicker skin just below the eyebrows. If that skin is ptotic (sagging), then there will be heaviness over the upper eyelid, and a loss of the “eyeshadow area”, that is, the space between the upper eyelashes and the brow itself. It is important to understand that you cannot remove brow skin as part of an upper blepharoplasty (eyelift). Rather, you should remove the excess skin of the upper eyelid and then elevate the brow back to its correct anatomic position. Sometimes, all you need to do is lift the brow laterally, which is a simple matter to do in most cases.
Browlifts may be performed in one of two ways: with conventional methods, in which the incision is hidden behind the hairline (for patients with thinning or receding hair, who are bald or who have had previous surgery in the area, the incision will likely be moved somewhere less conspicuous); or with an endoscope, in which a tiny camera and instruments are inserted through a few small incisions.
Conventional (Open) Browlift:
This can be performed via a “coronal incision” or a limited, lateral incision. They both have different purposes.
Coronal browlift: An incision is made from ear to ear across the top of the head. The incision is placed just behind the hairline in the front. The forehead is actually peeled down over the face. This gives excellent exposure to the muscles of the forehead and brow. All portions of the brow can be elevated with this technique. The downside is the large incision, the potential for hair loss in the scar, and numbness on the scalp behind the incision. This procedure can be combined with a facelift. This procedure was previously a commonly performed one, however, now it is not used as commonly since there are better techniques.
Lateral browlift: Many patients need mainly the outer brow lifted. This can be performed using a small four centimeter (about 1 3/4 inches) incision within the hairline near the temple. There is much less morbidity (problems) with this technique and it is a very nice procedure to complement a facelift or eyelift (blepharoplasty). It can be performed in less than a half hour in most cases.
The surgeon makes four short half inch incisions behind the hairline. The endoscope is placed in one so that the surgeon can see beneath the skin without having to make a large incision, while he or she lifts the skin and adjusts muscles through the other incisions. This technique works well in adjusting the muscles of the brow, but is somewhat lacking in its ability to elevate the lateral brow when the skin is lax.
In summary, the endoscopic technique is best for elevating the central brow, the open coronal technique is best for both the central and outer brow, and the open lateral brow technique is best for the outer, lateral brow, especially when there is redundant skin in that area. Patients with very short hair may want to let it grow before undergoing the open coronal technique surgery to better camouflage the healing scar.
Traditional surgery patients may experience some numbness and discomfort at the incision. Numbness could be replaced by itching, which will subside within six months. Your head may need to be elevated for two to three days to reduce swelling. Bandages are removed in one to two days, and stitches or clips are taken out in two weeks. Hair near the incision may fall out or thin, but normal growth should return within weeks or a few months. Sometimes the muscles that elevate the brow are weakened temporarily after the procedure, however, the ability to elevate the brows returns in a few weeks. This is rarely permanent.
With both procedures, you will be on your feet and able to wash your hair in a day or two, and many patients return to work or school in 7-10 days or less. Swelling and bruising should fade by the third week. Complications are rare and usually minor but may include temporary numbness, nerve injury, hair loss along scar edges, formation of a broad scar requiring surgical correction, infection and bleeding.