Browlift Surgery Explained
Browlift Before and After
What is a brow lift?
As we age, many people will notice that their brow will begin to droop. This occurs most commonly in the outer part of the brow, and will make the upper eyelid skin look heavy. Because of this many people may think that they need an upper eyelid surgery while they really need to elevate the brow. Doing an upper lid surgery can actually allow the brow to drop further and make the eye appear heavier than before.
If the central portion of the brow begins to fall patients may notice some horizontal lines forming at the bridge of the nose and the skin can appear very heavy there.
Properly placed Botulinum toxin can help to elevate a low brow. It will usually last for about 3-4 months at which time more will need to be injected. With time the injections may become less effective as the brow falls further. At that time a surgery will be a better option.
There are several options for brow lift surgery.
1. Direct brow lift: this is good for men with a good amount of brow hair. An ellipse of skin is excised along the superior edge of the brow. There will be a fine scar which usually fades after a few weeks.
2. Trichophytic brow lift: This is good for patients who also want to decrease the size of their forehead. An incision is made just inside the hairline above the forehead. Dissection is carried down to the brow in a deep plane under the skin. The forehead is elevated and excess skin is excised. The wound is then closed with sutures. This usually heals well with minimal scarring.
3. Temporal brow lift: An incision is made behind the temporal hairline. Dissection is done down over the temple to the outer corner of the eye. The skin is then elevated and excess skin removed. The wound is closed with staples.
4. Endoscopic brow lift: In this surgery, the temporal brow lift describe above is done. In addition 2-3 small incisions are made behind the hairline above the forehead. Dissection is done just above the bone down to the brow. The frown muscles between the brows are cut or excised. A dissolvable implant is placed in the bone and the forehead skin is elevated and hooked to the implant.
5. Coronal lift: This surgery is not performed often anymore. With a coronal lift an incision is made over the top of the head from ear to ear. The anterior scalp and forehead are then all elevated. While this surgery can provide a good elevation to the brow, it can produce a long scar over the top of the head. It will also elevate the hairline.
The direct brow lift can be easily done with local anesthesia. For the others IV sedation is preferred. During the brow lift there is dissection done directly over the bone. While not painful the sound can be disturbing to patients. There is also a lot of pulling involved with can be uncomfortable.
After the surgery the patient will be brought to the recovery room for 1-2 hours. Ice is applied to the forehead. A light dressing is frequently applied before discharge.
Many patients will have a bad headache for the first 24 hours, and will often require some prescription pain medication for this. Swelling and bruising are quite variable, and the bruising often migrates to the lower eyelids. Sutures and staples are removed at 7-10 days post-op.
For any of the surgeries done to elevate the central brow, there will be numbness over the top of the head which can last for several months. As the sensation returns many people will complain of an itching sensation.
There will sometimes be some decrease movement of the forehead from several days to several months. The motor nerve to the forehead can be stretched during the dissection which impairs its’ function. The brow on this side will appear low until the nerve function returns.
With an endoscopic brow lift, endotine dissolvable implants are placed into the skull. These will dissolve after 3-4 months, but until that time can be felt under the skin.
The main complaint for most patients relate to the nerve issues mentioned above – both sensory and motor. While bothersome these should resolve with time.
Over and undercorrection can also occur. Over correction can result in a startled look. This can occur more often if someone has already tattooed a brow in at a high level. With the surgery the tattoo will end up higher than desired. It is common to appear over corrected for the first week or two until the swelling starts to subside. Massage can sometimes help to drop the brow.
If under corrected, a revision may be necessary after 6 months. It is essential to wait until all nerve function is back since this will help to elevate the brow.
For any of the surgeries done behind the hairline, there can occasionally be some hair loss at the incision site. It this persists, the scar can be excised and the hair bearing skin brought together.