What are the pros of a brow lift? What can I expect to achieve, realistically?
How Effective is a Brow Lift?
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less of a browlift
Lateral Brow Lifts are Very Effective and can Produce a Natural Result
If there is a facial rejuvenation surgery that is over-recommended and often overdone these days, it is without question the browlift. Look no further than the celebrity photo magazines for pictures of stars who look like they have just sat down on a plate of tacks. The goal of aesthetic plastic surgery should be to make a person look better and more youthful, not merely different, and certainly not as though one is perpetually surprised. My goal is to provide my patients with results which appear natural, and an unnatural-appearing brow is a dead giveaway that a person has had facial plastic surgery.
I rarely see a patient that has such significant brow descent that I recommend elevation of the entire brow. However, I frequently see browlift patients for whom conservative elevation of the lateral brow produces a more rested, bright, and even elegant appearance. This is very easily simulated with gentle upward traction on the skin of the lateral forehead - if you feel that this may apply to you then try it in the mirror and the improvement will be quite obvious
A youthful, feminine brow rests above the level of the orbital rim, which is the upper margin of the bony socket in which the eye resides. An aesthetically pleasing brow is somewhat arched laterally, and the lateral end or "tail" of the brow is higher than the medial end. It is quite common for the female brow to assume an essentially flat or horizontal orientation as a person ages.
If the skin and soft tissues lose enough elasticity with age and sun exposure, the lateral brow may even descend to a level below the orbital rim, producing a tired or even 'surly' appearance. The medial brow is relatively fixed in position and in most cases does not descend much, if any. In years past, a browlift surgery required an incision across the top of the head, from ear to ear. This was replaced in the 1990's, for most surgeons, by the endoscopic browlift, which allowed the same procedure to be performed through small incisions just behind the hairline.
While I used endoscopic browlift techniques for several years to treat brow descent, more recently I have transitioned to performing a limited incision lateral browlift that does not require the use of an endoscope. The relatively short incision is hidden behind the temporal hairline, and no incisions are required in the scalp directly above the eyes. The advantage is as follows: this approach allows me to not only redrape the lateral brow (conservatively!) in a higher position, but it also allows me to reposition the skin and soft tissues of the lateral periorbital area in an upward direction, producing a more complete rejuvenation of the periorbital area.
Brow lifts are for real and give great results
The standard brow lift is a quick operation and gives a very predictable result. The eyebrows are lifted and can be made symmetrical in height with each other and the direction of the axis of the eye can be adjusted. The commonly hated wrinkles of the forehead can be markedly improved by cutting the frontalis muscle. The 11 lines between the eyebrows can be removed by resecting the corrigator muscles from the orbital rim. Recovery is about a week. Bruising is gone in about 10 days.
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Effectiveness depends on the type of Browlift
There are various types of brow lifts each with their own advantages and disadvantages:
1. Direct Brow lift - This is a procedure where an ellipse of skin above the brows is removed. Upside is that you have a long lasting effect, the downside is that the patient has an incision mark above the brow. I never use this in female patients, only in male patients with deep creases in the their forehead already where the incision line can be camoflauged.
2. Direct temporal Brow lift - This is similar to the procedure above except only the edge of the brow on the side is lifted. The incision tends to camoflauge better if skin is removed only on the side and not the middle or medial part of the brow.
3. Endoscopic Brow lift with Endotine - This is my most common type of brow lift where a small dissolveable tack is placed on the skull that lifts the brow underneath the skin. The incisions are hidden in the scalp. The upside is that there is no scar that can be seen, however the lasting effect is not as long as the direct brow lift variants. That being said, it is a great option and most female patients elect to get this procedure.
4. Coronal Brow lift - This is a procedure where an incision is made on the scalp close to ear to ear and the entire forehead skin is lifted and the overlapping tissue is excised. The large incision is located in the hair line. There are no endotines. There can be prolonged numbness in this procedure where the incision is placed near the top of the hairline. This has a longer effect I feel than the endotine but it is a little more aggressive surgery.
5. Brow Stitch Lift - This is where a stitch is placed in the lateral brow through the eyelid crease to lift the brow. This is a fast procedure that has much less downtime compared to options one through four, however I feel the lasting power is not as long.
A Brow lift can rejuvenate someone's look and is a very good procedure overall. Which one is for you depends on your needs and what your surgeon thinks is the best option for you.
Brow Procedures: Creating a Perception of Relaxation
In my hands, brow lifts are treated as brow relaxation procedures. Slight elevation of the brows can create a perception of relaxation and can minimize the need for upper eyelid surgery.
I explain to female patients that one of the goals is to elevate the brow, with emphasis on the lateral third or "tail" of the brow. Furthermore, the major goal of the procedure is not to achieve an Olympic record in brow height, but to create the perception of a more relaxed person. The second goal of a brow procedure is to minimize the central forehead lines through surgical division of the muscles that work in the glabella (corrugator supercilli and procerus).
I utilize two primary techniques in performing brow procedures:
The Endoscopic approach and the Trichophytic Approach. I make the decision on which technique to use (with the patient) based on the height of the patient's hairline. The advantages of the Endoscopic approach are: 1) smaller incisions within the hairline (typically four 1.5 cm incisions), 2) less recovery time. Typically an absorbable fixation device such as an Endotyne (absorbable implant) is used to hold the brow in position during the recovery period. The disadvantages include: 1) potential hairline elevation, 2) potential for less longevity of cosmetic benefit.
The advantages of the Trichophytic Approach (the incision is placed along the frontal hairline in an irregular wavy pattern, mimicking the normal advancement and recession of hair growth) are 1) a high hairline can be lowered or stabilized, 2) greater control over brow elevation, 3) hair will grow through the hairline scar, thereby concealing it. The disadvantages include: 1) a longer scar, 2) longer recovery time. Consultation with your surgeon will help determine which technique works best for you.
Brow relaxation procedures should generally be subtle; there are few tell tale signs of cosmetic surgery that are more obvious than an over elevated brow, or a patient with a high central brow position (quizzical look). In my opinion, a brow lift must be done very carefully in a male patient. Over elevation of the male brow lends itself to a more feminine appearance.
The Modern Browlift Beats Botox
The browlift operation has evolved in conjunction with endoscopic techniques but only came into its own when fixation and direct forehead muscle weakening were added to the mix. Fixation with bioabsorbable material allows accurate elevation of the brow so that the over- elevated brow (the Kenny Rogers effect) is rarely seen. Direct access to forehead and glabellar muscles and techniques to weaken these muscles has improved the longevity of the surgery and lessened the need for subsequent Botox injections.
Brow Lift is very effective in achieving a refreshed look
As we age, our skin loosens and wrinkles, causing drooping of the forehead area as well as creases and lines that can make us appear angry, sad, old or tired. A forehead lift can address these problems by surgically altering the muscles and tissues that cause wrinkling and/or drooping in the area above the eyes. It can also help people of any age who have developed furrows or frown lines due to stress, sun damage or muscle activity. People with inherited conditions, such as a low, heavy brow or furrowed lines above the nose can also achieve a more alert and refreshed look with this procedure.
The reasons to get a brow lift are few and simple
Since the development of the endoscopic technique, brow lifting has gained popularity with both patients and doctors. Gone are the days of open procedures with big incisions, long healing times and a potential for noticeable scarring. Endoscopic Brow lifting is an excellent, minimally invasive procedure, that provides high levels of satisfaction in the properly selected patient. It also helps to provide better balance to the face when other procedures, such as facelifts, midface lifts, and lower eyelid lifts are being done.
Brow lifting is indicated for patients with moderate to severe upper eyelid aging. Skin excess can create a narrowing of the eye opening. Problems with vision may occur if the skin hangs over the eyelid margin towards the side of the eye, physically blocking your visual field. When the eyebrows have fallen significantly, some of this "extra" skin is actually brow skin, which can not be removed with a blepharoplasty alone. If visual field problems are medically documented, then insurance can sometimes cover the procedure.
So, while upper eyelid blepharoplasty or upper eye lifts alone can be effective for patients with mild to moderate problems, brow lifting must be done in order to ensure a good result in people with more advanced problems. Brow lifting can also help to reshape the contour of the eyebrow or create better eyebrow symmetry. It can also be done to avoid the need for blephroplasty in patients with low brows and early upper eyelid skin excess.
Since the procedure is endoscopic, there are only small incisions hidden within the hairline. The bruising and swelling that occurs is typically gone within a week and results do endure. There are very few complications that can occur, such as numbness of the forehead or infection. However, these are exceedingly rare in the right hands.
Finally, like other procedures in plastic surgery, your anatomy may affect the result. Patients with heavy forehead and brow skin, male patients, and those with more shallow eye sockets will not have as much lift as those with thin skin or more deeply set eyes. However, as long as your surgeon explains these limitations, then you will likely be happy with the result you can achieve.
When performed properly, it's an excellent procedure
The key to a browlift, much like most of cosmetic surgery, is picking the right procedure for the right patient. Some patients are excellent candidates for a browlift, while others really only need eyelid surgery, so the first step is to consult with a Board Certified Plastic Surgeon who can analyze each aspect of your upper face carefully, including the arc or shape of the brow, the position and symmetry of your brows, the position of your hairline, and the amount of excess upper eyelid skin and fat that you may have.
The next question is what type of browlift to perform, as they each have different pros and cons. Options include a bicoronal browlift, endoscopic browlift, temporal lift, or limited incision lateral browlift, among others. Here, again, the key is for the surgeon to sit down with you, analyze both your anatomy, and just as importantly, review with you in careful detail what your specific goals are, and pick the procedure that is right for you. Some patients desire a very dramatic difference, while others want the brow position to be altered just slightly.
In the end, pick your surgeon carefully and ask to see some before and after photos to give you a sense of what results you could expect.
Best of luck,
Endoscopic Brow Lift Helps Patients Achieve a More Youthful Appearance of the Brow & Forehead
Facial aging is frequently associated with descent of the brow. This results in the brow sitting at a lower than normal level which tends to make the patient look unhappy and on occasion, angry. It’s part of the characteristic findings that are seen with the aging process.
The brow lift has historically been performed in conjunction with facelift procedures in an effort to rejuvenate the facial appearance. Historically, this has been performed by making an incision across the top of the head and pulling the skin in an upwards direction. Frequently, scars have been associated with this technique and elevation of the anterior hairline.
Endoscopic brow lift represents a significant advance in plastic surgery. With this technique, small incisions can be made behind the hairline and a small scope inserted beneath the skin, which can be utilized to separate the soft tissue of the forehead from the underlying bony structures. The skin is then repositioned, utilizing an anchoring device behind the hairline. This results in a much more youthful appearance of the forehead. It is frequently performed in conjunction with facelifts and upper eyelid surgery, as part of an effort to totally rejuvenate the aging face.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.