Is Brow Lift Surgery

Is Brow Lift Surgery

A brow lift is a surgical technique used to improve the appearance of aging eyes by repositioning the forehead. Skin elasticity decreases with aging. Wrinkles form when gravity pulls down on your brow and the sun’s rays have weakened your skin over time.

It’s important to find a board-certified surgeon with extensive experience in facial anatomy and movement if you want a successful brow lift. Dr. Castillo and his staff solely employ cutting-edge procedures. With 21 operating rooms, our cutting-edge facility can get patients back to work quickly. Our sister locations, which perform procedures like breast augmentation and tummy tucks, are located in the same building in Torrance, California, where you may also have your preoperative evaluation and consultation.

Brow lift surgery is growing in popularity across the UK as people age. It is commonly known as upper blepharoplasty, or colloquially as “eye lift surgery” and involves a surgical procedure to remove excess skin from the brow and reshape the eye area to give a more youthful appearance. Read on to learn more on direct brow lift/brow lift vs blepharoplasty.

Is Brow Lift Surgery

The face is one of the first to show signs of aging. When wrinkles and fine lines appear around your eyes and on your forehead, they can make you appear older than you actually are. Brows that are burrowed due to wrinkles can also make you look chronically tired.

Unfortunately, diet and exercise are not able to prevent this type of aging. This is when facial plastic surgery can play a signfificant role in dramatically transforming your appearance. A brow lift, or forehead lift, is the surgical lifting and smoothing of the forehead to create a more rested, youthful appearance. Most people have a brow lift for cosmetic reasons. A brow lift reduces the signs of aging, including creases and fine lines on the forehead and between the eyebrows. Brow lift surgery can also reposition low or sagging brows that hood the upper eyelid.

A brow lift is a common but major surgery that has risks and potential complications. You may have less invasive treatment options, such as Botox injections. Consider getting a second opinion about all of your treatment choices before having a brow lift. 

What You’ll Need at Home After a Brow Lift

Make sure your house is stocked with plenty of gauze and clean towels for when you get home after your brow lift. Also make sure you have the following on hand:

• Plenty of ice
• Container to use for ice or cold water
• Plastic freezer bags to hold the ice, or bags of frozen corn or peas to use in place of ice
• Pillows (you’ll have to keep your head elevated for a period of time)
• Ointment for the incision area (which your surgeon can recommend or prescribe, if necessary)

The Basic Approach

The brow (or forehead) lift is often the best way to get a long-lasting and noticeable change. During this treatment, the doctor will make an incision at some point near a patient’s hairline or forehead, removing a small amount of skin in the process. This causes the remaining skin to become stretched after the incision is closed and healed.

The brows are lifted, and the forehead and frown lines are smoothed out. Because this is such a frequently performed treatment, it is very rare for patients to experience any complications.

A Versatile Treatment

There are multiple available approaches to a forehead lift. Each approach uses an incision or set of incisions in a different location. Endoscopic, coronal, or hairline lifts can all help personalize your results, making this a versatile and customizable treatment.

Combining a Brow and Eyelid Lift

Combining these treatments is popular, especially in cases where the eyelids also need surgery. An eyelid lift (or “blepharoplasty”) is a frequent companion to a forehead lift.

The Non-Surgical Option

At Adoro Medical Spa in Severna Park, MD, we also offer a non-surgical treatment option for patients who would like another approach. We perform this using a technique called Thermage FLX. Thermage is performed in our office, and although its effects are more subtle, they can continue to improve for months following treatment. There is no downtime necessary and complications are very rare. For patients who would prefer a more gradual and lower-impact treatment, Thermage is an excellent choice.

Direct Brow Lift

The upper face, including the eyebrows and periorbital regions, plays a dynamic role in the aging face.[1] With the natural aging process, the position of the brow relative to the supraorbital rim may become ptotic. Commonly, this presents as excessive hooding of the lateral eyelid but, in severe cases, may result in a visual field obstruction.[2] Other less common causes of this phenomenon may be due to acquired facial paralysis or secondary to post-traumatic deformity. Various surgical options exist to reposition the brow, ranging from traditional open techniques to newer endoscopic approaches. Each technique has its respective strengths and weaknesses, but no individual procedure has proven superiority in all clinical scenarios.[3] 

Recently, there have been trends in aesthetic surgery towards the utilization of the endoscopic browlift technique.[4] Nevertheless, traditional open approaches remain a fundamental skill in the armamentarium of the facial surgeon as it provides the greatest degree of accuracy in relation to brow repositioning. Herein we outline the nuances of one of these open approaches, the direct brow lift, and focus on its role in rejuvenating the upper third of the face.

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Anatomy and Physiology

The upper third of the face exhibits many characteristic signs of aging, including:[5]

• Horizontal midforehead lines, secondary to the vertical action of the frontalis muscle.
• A fullness of the upper lateral eyelid, caused by downward migration of the upper facial soft tissues resulting in brow ptosis. 
• The vertical and oblique glabellar lines secondary to the action of the corrugator supercilii and the depressor supercilii (i.e., superomedial orbicularis oculi muscle). 
• Horizontal lower midforehead lines, secondary to the action of the procerus muscle. 

Brow Lift Methods

As mentioned previously, multiple surgical approaches have been created to address the ptotic brow, including:[1]

• Direct Brow Lift: superior brow incision used to camouflage at the level of the eyebrow hair follicles.
  • Allows for the most precise repositioning of the brow 
  • Best suited in cases of unilateral facial paralysis.
• Midforehead Brow Lift: Incision planned at the level of the midforehead, ideally within the confines of a preexisting horizontal rhytid.[6]
  • Allows for bilateral brow repositioning with a single incision
  • Best suited for men with a receding hairline and deep forehead rhytids.
  • May consolidate multiple rhytids into one transverse rhytid. 
• Hairline Brow Lift: Incision planned either within (trichophytic) or just in front (pretrichial) of the hairline.[7]
  • Allows for the bilateral elevation of the periorbital soft tissues
  • Useful in patients with elongated foreheads as this may lower the patient’s hairline
  • It may be combined with a hairline advancement if warranted.
• Coronal Incision Brow Lift: Incision made several centimeters behind the hairline.
  • The incision is completely hidden within the substance of the hair.
  • Avoid in patients with elongated foreheads, as this will elevate the patient’s existing hairline.
  • Avoid this procedure in bald patients, as this may leave an unsightly scar.
• Endoscopic Brow Lift: Multiple small incisions made within the frontal and temporal hairlines to allow for the insertion of the endoscope and surgical instruments.[4][8]
  • Minimally invasive approach with a theoretically decreased risk of injury to neurovascular structures and quicker healing times
  • Not well-suited for patients with receding hairlines or convex forehead structure, which may restrict endoscopic visualization 
  • Requires fixation, typically with absorbable materials (e.g., sutureless bioabsorbable implants, sutures), to reposition and stabilize the forehead soft tissues 
  • A technical learning curve exists.
  • Only provides moderate brow elevation (several millimeters)

Pertinent Anatomic Structures[9]

• Supraorbital Nerve (SON): Exits a notch or foramen roughly 2.7 cm lateral to the midline forehead (may be approximated to the level of the medial limbus). The SON further divides into deep and superficial branches that provide sensory innervation to the frontoparietal and upper eyelid skin, respectively.[10]
• Supratrocheal Nerve: Usually identified 1 cm medial to the exit point of the supraorbital nerve. This provides sensory innervation to the medial upper eyelid, glabella, and a small portion of the conjunctiva.[10]
• The Temporal Branch of Cranial Nerve VII (Facial Nerve): Provides motor innervation to the forehead (frontalis) and upper orbicularis oculi. The path of this nerve may be approximated by Pitanguy’s line, which is a line drawn from 0.5 cm inferior to the tragus to a spot 1.5 cm superolateral to the lateral brow).[11]

Ideal Brow Location and Shape

• For women, the ideal brow position takes the shape of an arch with its peak roughly at the level of the lateral limbus.
• In men, the ideal brow remains relatively flat and positioned at the level of the supraorbital rim. 

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Indications

Indications for any type of brow lift surgery may include:[12]

• Visual field obstruction
• Psuedo-blepharoptosis (eyelid appears to be lowered, but no pathology of the eyelid musculature or levator aponeurosis is present)
• Brow ptosis
• Facial paralysis
• Facial (brow) asymmetry
• Deep forehead rhytids
• Glabellar lines
• Concerns regarding the perceived resting facial aesthetic (e.g., an “angry” or “tired” look)

Clinical situations favoring a direct brow lift approach:[13]

• Lack of forehead rhytids
• Unilateral facial paralysis
• Convex forehead craniofacial skeleton (limits endoscopic approach)
• Receding hairline
• Baldness
• Heavy eyebrows
• Prior eyebrow scar
• Patient preference

In either case, you will have stitches or staples that will need to be removed in about a week. If you have temporary fixation screws, your surgeon will remove them in about two weeks. These fixtures are installed beneath the hairline to hold the elevated brow in place.

You will probably have swelling and bruising that can affect parts of your face that wasn’t operated on, including your cheeks and eyes. The swelling should be gone in about a week. For at least two days after the surgery, you should keep your head elevated to help ease the swelling, and you can gently apply ice packs to the affected region.

If your surgeon used the classic method, you will most likely experience more pain during your recovery. Your doctor will give you a prescription for a painkiller. You may also experience more itching, which can last a few months.

After the endoscopic procedure, you will also get a prescription painkiller. Itching can be a side effect, but it should be much milder than with the classic method.

In either case, you may also have numbness or tingling. This will ease over time. Those who have the classic procedure may have more numbness.

Most people can return to work or school within 10 days depending on which procedure was performed and your own personal rate of recovery.

Avoid heavy lifting, vigorous exercise, or other activity for the first few weeks after surgery.

Though the side effects are minimal, possible complications can include infection, scars, complications with eyebrow movement, or the loss of sensation around the incision site. It’s important to remember that these complications are rare.

Brow Lift Vs Blepharoplasty

Both brow lift and eyelid surgery can give your face an overall healthier, younger, more refreshed look. Initial wound healing from a brow lift takes around two weeks, the same as a blepharoplasty.

The main difference between the two cosmetic procedures is the area of the face each surgery addresses:

• A brow lift targets the skin and soft tissue in the forehead. On the other hand, a blepharoplasty removes extra skin and fat from the eyelids (upper and lower)
• A blepharoplasty can improve the appearance of the eyes, but it does not reposition the eyebrows. Alternatively, a brow lift surgery lifts the eyebrows and improves the appearance of the upper eyelids without removing any skin and fat from the eyelids
• A brow lift incision is made along the hairline in the forehead, whereas blepharoplasty incisions are made along the natural creases of the upper eyelids

NOTE – Some patients mistakenly have blepharoplasty surgery when they really needed a brow lift.

How Do I Know If I Need a Brow Lift?

A brow lift surgery is ideal for people with a low brow position.

You might need a brow lift if you’re constantly raising your eyebrows to see better or if you look in the mirror and raising your eyebrows makes your eyes look wider and more alert.

Moreover, if you notice deep wrinkles and frown lines on your forehead, a brow lift can also address those cosmetic concerns.

You probably don’t need a brow lift if you have eyebrows that naturally sit high on your forehead. In this case, a forehead lift would raise your eyebrows even higher, making them look unnaturally high. As a result, you’ll look surprised the entire time.    

How Do I Know If I Need Blepharoplasty?

You probably need blepharoplasty if you have heavy, sagging eyelids and bags under your eyes that make you look tired all the time.

Additionally, eyelid surgery might be the most suitable treatment option for you if your heavy eyelids are obstructing your vision.

If you raise up your eyebrows and that doesn’t improve your vision or how your eyes look, then you’ll likely benefit from a blepharoplasty more than you would from a brow lift.

On the other hand, if raising your eyebrows improves your vision and appearance, then eyelid surgery might not be the best option for you. Consider a Brow Lift.

Which Is Better – Blepharoplasty Or Brow Lift?

Many patients with sagging eyelids wonder which procedure is better for them, a brow lift or a blepharoplasty. 

Choosing between a blepharoplasty or brow lift surgery depends on several factors, including:

• The current condition of your upper face, skin and eyes
• What cosmetic concerns you want to address with surgery
• Your desires – What look are you hoping to achieve with your surgery

Regardless of which cosmetic procedure you’re hoping to get, you must always consult with an experienced plastic surgeon before coming to a decision.

Dr Scott Turner is an expert in facial plastic surgery and has significant knowledge in facial anatomy and eyelid functions. He’ll examine your face, assess your individual needs and goals, and advise you on which procedure can give you the best results.

In general, blepharoplasty is most suitable for patients with:

• Hooded eyelids
• Bags under the eyes
• Obstructed vision because of droopy upper eyelids

However, eyelid surgery alone doesn’t do much to correct fine lines and wrinkles around the eyes.

Alternatively, brow lift surgery is ideal for patients with:

• Droopy eyebrows
• Fine lines and wrinkles on the forehead
• Obstructed vision because of heavy low eyebrows 

Can You Combine a Brow Lift With Blepharoplasty?

A blepharoplasty and brow lift surgery are often combined to rejuvenate the appearance of both the eyelids and eyebrows.

In some patients, a brow lift on its own or a blepharoplasty on its own might not address all the cosmetic concerns a patient would like to correct.

In some patients, there isn’t enough skin or tissue in the eyelids to remove during eyelid surgery. In those cases, the surgeon can remove a small amount of tissue from the eyelids and then lift the eyebrows to maximise your results.  

In other cases, the eyebrow might sag even more if your surgeon removes excess skin and tissue from the upper eyelids. In such cases, simultaneous brow lift surgery helps stabilise the position of the eyebrows and prevent further drooping.  

Another benefit of combining those two procedures is that the patient gets to have a tighter forehead in addition to wider, more alert eyes.

When necessary, Dr Turner can perform a brow lift at the same time as a blepharoplasty. That allows you to receive the benefits of the two cosmetic procedures while going under anaesthesia only once and through only one recovery period. 

Combining eyelid surgery with a brow lift can help you achieve an overall fresher and more youthful appearance.

Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments. 

It is also a good idea to bring a list of questions to your appointments. Questions can include:

• Am I a good candidate for a brow lift? Are there any other options for treating my condition?
• What type of brow lift procedure will I need?
• How long will the procedure take? When can I go home?
• What restrictions will I have after the surgery? When can I return to work and other activities?
• When can I shower after brow lift? How should I care for my incisions?
• How will I look after the surgery?
• What kind of assistance will I need at home?
• How do I take my medications?
• How will you treat my pain?
• When should I follow up with you?
• How should I contact you? Ask for numbers to call during and after regular office hours.

How might brow lift affect my everyday life?

You will not be able to color, straighten, or perm your hair for at least a month after surgery. It is a good idea to get these hair treatments done before  surgery.

A brow lift can make you look younger, more alert, and feel better about yourself. Many surgeons caution that it is important to be realistic about how much a brow lift may improve your self-image. It is important to be aware of what a brow lift can and cannot do for your overall appearance and self-image.