A brow lift is a surgical procedure that addresses age related changes of the forehead and eyebrows by raising the skin and muscles of the forehead. A browlift also permanently treats the underlying facial muscles of the forehead to provide smoother skin and eliminate frown lines.
Candidates for Browlift Surgery
Healthy women or men that have sagging of the brow below its once youthful position at or above the bone of the eye socket are candidates for browlifting. The sagging of the brow may also contribute to wrinkling of the upper eyelids, giving patients an overall all tired look. In addition, some patients may have deepening of the horizontal lines of expression across the forehead or more pronounced vertical wrinkles between the eyebrows, giving the appearance of a questioning or frowning appearance. Treating these wrinkles due to facial expression by weakening the corrugator and procerus facial muscles is often part of a Browlift. Also a brow lift is performed in combination with a blepharoplasty (eyelid surgery) to improve the appearance of the entire upper third of the face. While many of the incisions are well concealed due to their location in the hairline, a brow lift can still be performed in patients with thinning hairlines or with bald scalps.
What is involved in a brow lift?
A brow lift involves raising the skin and muscles of the forehead to their normal anatomic position and smoothing forehead lines and wrinkles to achieve a fresher, youthful look. The procedure involves making a series of incisions within the hairline that allows access to the underlying musculature of the forehead and brow. Drs. Montante and Zemmel use a small fiberoptic camera to perform the surgery. The skin of the forehead is released and lifted, the muscles which cause frown lines and forehead creases are disabled, and the skin of the forehead is anchored down at a higher level. Through a variety of anchoring techniques, the muscles and associated soft tissue can be elevated to a more anatomic position.
What types of brow lifts are there?
There are three primary types of brow lifts that are primarily used to address the aging forehead: the conventional (or coronal) brow lift, the lateral brow lift, and the endoscopic brow lift.
The Conventional Brow Lift
The conventional brow lift is a procedure that has stood the test of time and is useful in addressing significant soft tissue laxity of the forehead. It involves an incision which starts in the hair at the level of the ear and extends over the crown of the head to the other ear. Skin and muscle flaps are then elevated and advanced toward the top of the head. The excess skin and soft tissue is removed, resulting in an elevation of the entire forehead and eyebrows. In certain cases of a high forehead or receding hairline, the incision is placed along the frontal hairline to avoid extending the height of the forehead. This procedure is best suited for patients with extensive loosening of the brow and forehead. Fortunately, in most cases, the conventional brow lift has been supplanted by less invasive techniques that can achieve natural-appearing brow rejuvenation in the majority of patients. The disadvantages to this procedure are potential changes to the hairline, scalp numbness along the incision, and hair loss adjacent to the incision.
The Lateral Brow Lift
The lateral brow lift is a technique that has evolved from the conventional brow lift that involves limited hairline incisions that parallel the outer portions of the eyebrow. One of the hallmark features of the youthful forehead is the natural peak of the tail of the brow. As the forehead ages, the brow sags and the peak shifts more toward the center of the forehead or is lost altogether. The lateral brow lift addresses one of the most common age-related changes to the forehead with relatively limited incisions, and avoids of some of the disadvantages of the conventional lift, and gives a faster recovery.
The Endoscopic Brow Lift
The endoscopic brow lift is the least invasive procedure for forehead rejuvenation. The procedure involves a series of small incisions within the scalp in which specially designed instruments are inserted to free the underlying forehead skin and muscles from their deep bony attachments. In order to visualize these tissues clearly, an endoscope (a small fiber optic camera attached to a monitor) is inserted through one of the incisions. This provides Drs. Montante and Zemmel a clear field of view to not only perform the necessary tissue elevation, but also to identify and remove some of the small muscles between the eyebrows that commonly cause vertical worry lines. The eyebrows are then lifted to a more anatomic position and fastened with a small clip that will dissolve over time.
Which procedure is right for me?
The determination of which procedure will best suit an individual patient involves a careful preoperative analysis of overall facial anatomy with specific attention to the eyebrows and forehead. Drs. Montante and Zemmel will perform a thorough analysis of:
- The brow position in relation to your underlying bony features
- The position of your frontal hairline
- The quality and tone of your facial and forehead skin
- The overall height of your forehead
- The underlying tone of your forehead muscles
- The position and shape of your upper eyelids
Based on this analysis, you will be provided with their recommendations to achieve the improvements you are seeking.
Before Your Brow Lift Surgery
In addition to performing a detailed analysis of your specific forehead concerns, Drs. Neil J. Zemmel and Steve J. Montante will perform a thorough evaluation of your overall health status. They will pay particular attention to any underlying medical conditions that may affect your results, such as uncontrolled hypertension or diabetes, smoking, and a history of scarring following previous surgery. Based on your history, you may be asked to see your primary care physician prior for a preoperative assessment. Please inform the Richmond Aesthetic Surgery team of any difficulties you may have had with prior surgeries, of all current medications you may take, including supplements, and whether you are actively smoking. If you are an active smoker, you will be asked to stop smoking for at least 6 weeks prior to surgery and to cease smoking for 6 weeks after surgery. Smoking cessation will minimize your risk of potential complications in wound healing and maximize the likelihood of an excellent result.
Within a week or two of surgery, you will meet with Dr. Zemmel and Montante again to review the operative plan and goals. It is a great time to have any questions you have answered. Feel free to write down any and all questions after your initial visit to ensure they are all answered prior to surgery. Before the day of surgery, the RAS team will provide you with instructions for the day of surgery, postoperative instructions, and any prescriptions you may need following surgery when you get home.
The Day of Your Brow Lift Surgery
On the day of surgery, you will meet Drs. Montante and Zemmel to ask any final questions that you may have. You will meet a Board Certified Anesthesiologist and Nurse Anesthetist who will provide your anesthesia. A brow lift can be performed under deep sedation or general anesthesia. Please inform the Anesthesia team of any particular difficulties you may have had with prior surgeries, especially anesthesia-related nausea. You will meet our experienced intraoperative nursing staff who will care for you during surgery. A browlift usually takes approximately 1 hour; however, surgical times may be longer if additional procedures are performed.
Once asleep in surgery, your hair will be gathered into small “pony tails” adjacent to the planned incisions to keep hair out of the surgical wounds. The incisions will be performed in such a way so that hair will grow through the scar to minimize the risk of hair loss adjacent to the incision. The incisions will be closed with either sutures or staples that will be removed in 10-14 days following surgery. In the case of the conventional brow lift, you may have a soft drain placed under the skin incision, which is usually removed within 24-48 hours following surgery. After surgery, you will be taken to the recovery room for immediate postoperative care. A brow lift can usually be performed as an outpatient procedure. However, if additional procedures are performed in conjunction with a brow lift, Dr. Montante or Dr. Zemmel may admit you to the hospital overnight to provide you with round the clock nursing care that can address any pain or nausea that you may develop.
After Your Brow Lift Surgery
Shortly after surgery, you can expect mild pain that is well controlled with oral pain medicines. You will most likely experience forehead swelling and bruising which usually resolves within 1 to 2 weeks after surgery. It will be very important to keep you head elevated for the first 3 to 5 postoperative days to assist in resolution of initial swelling.
At approximately 10-14 days postop, all staples or sutures will be removed. As the swelling subsides and the incisions heal, you may experience a numb sensation on the crown of your head, especially after a conventional brow lift. This numbness may persist for up to 6 months following surgery. In less invasive brow lifting techniques, the numbness is more limited and should resolve much quicker.
Drs. Zemmel and Montante may advise patients to allow at least 7 to 10 days free from work and strenuous activity to recover from a brow lift. Prior to surgery, the Richmond Aesthetic Surgery team will provide you with more detailed instructions that outline activity restrictions.
Like many of the facial rejuvenation procedures offered by RAS, your results will gradually emerge as swelling subsides. You will notice a “fresher” and “rested” appearance to your forehead with less drooping of your eyebrows and your upper eyelids.
Complications of Brow Lift Surgery
Complications from brow lift surgery can occur but are rare and usually occur less than 3% of the time. Delayed postoperative bleeding may result in the collection of a small blood clot deep to the surgical incisions (a hematoma). Depending on its size, a hematoma may require a return to surgery for removal. As described above, some patients may experience some hair loss at the site of the incisions. Some patients may develop thickening of the scar, especially in a conventional brow lift. Rarely, patients may notice some asymmetry with respect to brow position that may require additional revision surgery.
There may be some degree of scalp numbness, which will vary with the type of brow lift procedure performed. In the majority of patients, this numbness is temporary and will resolve within a few months. In rare instances, the numbness may be permanent. Temporary or permanent injury to the nerves that control movement of the forehead is the most significant complication of brow lifts. Correction of this rare complication frequently requires additional surgical procedures.
How can I learn more?
To learn more about brow lift surgery please schedule an appointment with Dr. Neil J. Zemmel or Dr. Steve J. Montante, please contact Richmond Aesthetic Surgery today for your complimentary consultation.