Facial expressions are an important part of our overall body language, yet over the years certain expressions can an impact on the forehead and brow area. Are you frustrated by people telling you that you look angry, sad or tired all the time? This can happen when the brow area is low or sagging, even creating a hooding effect of the upper eyelids. If this is what you see when you look in the mirror at yourself, you may be a candidate for a brow lift, also known as a forehead lift. The benefits of a brow lift surgery include a softening of the creases across your forehead, at the top of your nose and between your brows. In addition your eyes will appear more wide open and your facial expressions will no longer be characterized as sad or angry, but rather relaxed and rejuvenated.
Am I a candidate?
Many of the brow lift candidates have been treating the symptoms of a sagging brow and forehead creases with Botox and injectable fillers. An ideal candidate has deep horizontal creases across the forehead, furrows between the eyebrows and sometimes sagging skin at the top of the nose that improves when you take your fingers and lift up the skin on that area. If your eyebrows are sagging, which you can often tell just by placing your finger on your brow bone, to see if the eyebrow has dropped below the bone, and you notice that the upper eyelids are hooding creating a tired look, you are a good candidate for a brow lift, or forehead lift. If you are considering a facelift you may also be an ideal candidate for a brow lift at the same time.
The Brow lift procedure can be performed in more than one way. Our Plastic Surgeon is capable and comfortable performing a Brow Lift using any one of these techniques, although he prefers the minimally invasive approach when applicable. An endoscopic Brow Lift is the most common technique used for this type of procedure, as it is minimally invasive. Through the use of an endoscope, the surgeon is able to see and operate on the internal forehead structures with the use of a tiny camera, viewing the structures on a monitor in the operating room. This is the basic premise of all endoscopic procedures. The advantage of this technique is that this type of lift allows for repositioning of the forehead and eyebrows to the desired position without the need to remove any skin in most cases. This particular procedure is particularly effective in younger patients or those not requiring removal of excess skin. This equipment is expensive, and most surgeons who do not perform many brow lifts may make the investment.
A more traditional approach is the Coronal Brow Lift, which requires the plastic surgeon raise the total brow through an incision either over the top of the head from ear to ear in the hairline or behind it. The next step is to remove the excess skin and tissue, and reposition the brows to a more youthful position. The approach has been used far less frequently since the introduction of the minimally invasive approach, but is indicated in some patients. There are some who believe this more traditional approach can actually achieve more lift, than the endoscopic approach.
One final technique that can be used to treat the sagging brow is a Temporal Brow Lift. This involves the surgeon elevating the outside part of the eyebrows through an incision made at the temples, hidden behind the hairline. A second incision may be made in the upper eyelids to treat the glabella if frown lines are present between the brows. The purpose for this step is to give the eyes a more open rested youthful appearance. Our surgeon likes to have the patient receive a Botox injection to the forehead about 2 weeks prior to the procedure. The benefit of this is to get the brow and forehead to relax as much as possible, so that when the brow lift is performed the maximum lift result is achieved.
As with all of our cosmetic procedures the Brow Lift is performed in our state licensed in-office surgical suite, under IV sedation. It is done on an outpatient basis, so that once you are in recovery and alert you may leave after no less than one hour after the surgery is completed. During the initial phases of healing, it is not uncommon to experience, swelling, numbness, and some minimal discomfort, that is easily tolerated with the pain medication we prescribe. The greatest amount of discomfort will be experienced in the first couple of days following the surgery. You may also notice the some facial movements can be impaired, but that is a temporary side effect. The doctor will give you instructions to keep your head elevated, and let you know when it is safe to bathe and wash your hair, which may be a few days. You will need to avoid strenuous physical activity, lifting and bending as instructed by the doctor. Most patients who have a brow lift are able to return to light duty work in a week and sometimes less depending on the way they are healing. If the brow lift was done with an incision it is critical that the patient use sun protection, until the healing process is complete to minimize scarring. Once a newer scar is tan it is very difficult to get it to lighten, and the goal is to have the scar as invisible as possible over time.
Is there anything that can be done post surgically to enhance the results of the brow lift procedure?
We have all of our cosmetic patients see an aesthetician in our medical spa, for the purpose of trying to maximize the results. Good skin care is essential following the brow lift, and some laser treatments and peels may help with the fine lines and wrinkles that may linger after the procedure.
What age is the typical brow lift candidate?
Many of the patients are over 50, however there are a number of individuals for various reasons have the sagging skin, deep forehead creases and tried looking eyes at a younger age. If the symptoms can be temporized with BOTOX® Cosmetic, many choose that initially but end up having some type of brow lift for a more permanent result as the condition worsens.
Glabella – This is the area between the eyebrows where you can get visible vertical lines when you scowl.
BOTOX® Cosmetic – This is a neurotoxin that when injected into an area such as the forehead paralyzes the muscles, thus making it difficult to make the facial expressions that create the wrinkled look.
Hooding – This is a reference to having the eyelids look hooded, an indication someone may need a brow lift. Hooding is when the lid appears to hangover the eyelash area, so you seem to have no real upper lid that is visible. It is particularly noticeable towards the outer corners of the eyes. The hooding is what makes people look so sad and tired when in actuality they are not.