Upper facial aging is frequently “overlooked” as a problem in facial aging. However, descent of the forehead and eyebrows leads to deep forehead creases and “crowding” of the eyes, which leads to a tired look with “heavy” eyebrows; it may even lead to an angry appearance. In females, this may lead to difficulty applying upper eyelid makeup. Even though neuromodulators (such as BOTOX®, Dysport®, Xeomin®) may improve some forehead creases and minimally lift portions of the eyebrow, there are limitations as to what injectables can accomplish. As a matter of fact, it is sometimes the eyebrow descent creating perceived upper eyelid skin redundancy, and hence brow surgery (rather than eyelid surgery/blepharoplasty) would be the appropriate procedure of choice. In carefully selected patients, forehead and eyebrow rejuvenation can be achieved through contemporary endoscopic techniques to reduce and reverse some of the effects of upper facial aging.
Who is a good candidate for browlift/forehead lift?
Browlift surgery is not the appropriate procedure of choice for everyone. Your surgeon will discuss your needs and expectations to help determine if this procedure will be appropriate for you. In general, these are the characteristics of good candidates for browlifts:
- Eyebrows that rest below the upper orbital rim
- Lower and dense hairline (better for scar camouflage)
- Relatively flat forehead
- Thinner skin
- Good general health
- Reasonable expectations of what the procedure will and won’t be able to accomplish
How is a browlift/forehead lift performed?
There are many different approaches for browlift surgery. The decision as to what approach is most appropriate is customized to each patient and depends on patient, anatomical, and surgeon factors. A detailed consultation and discussion is necessary to decide on the most appropriate procedure for you.
A browlift is usually performed under general anesthesia although some surgeons prefer to use intravenous sedation. Your surgeon will discuss the options with you and make a decision based on your individual needs and the procedure(s) performed.
Several techniques exist to effectively improve eyebrow position. In patients with severe brow malposition and functional impairment, a direct method is occasionally utilized to adequately open the eye aperture and reverse visual field obstruction. However, in most cases, an endoscopic approach is utilized to correct eyebrow malposition using the most contemporary techniques and instrumentation to create a natural brow position and shape. Through the endoscopic approach, a few short vertical incisions are made in the hairline so that visible scars are avoided. Using an endoscope attached to a camera, the eyebrow attachments are released and the muscles are treated to create a more favorable and natural brow position and shape. At the end of the procedure, the hidden incisions are closed and a dressing is applied. After awakening from anesthesia and confirming your comfort, you will be able to go home the day of surgery.
The dressing is removed the day after surgery. Some bruising, swelling, and temporary forehead numbness are to be expected following this procedure. Swelling may be minimized by a cool compress, head elevation, and light activity. For a short period, there might be tightness, headache, and nausea, all of which are treated with medications as necessary. After 1 week, all sutures are removed and most bruising and swelling has subsided.
The overall recovery after surgery somewhat varies amongst patients and is mostly based on which approach was used. However, most patients are able to go back to work 10-14 days after an endoscopic browlift. Normal activities may be resumed after 2 weeks with the exception of heavy lifting and strenuous physical activities. Hair coloring should be postponed until approximately 6 weeks after surgery but may be performed shortly before the surgery. Patients flying in for the procedure should make arrangements to stay in town for at least 1 week. Full healing and recovery may take several weeks with swelling and final brow position improving during the first 3-4 weeks. If you would like to find out if a browlift/forehead lift is what you need to brighten your look and smooth forehead wrinkles, call and set up a consultation today!