When should you consider a Brow Lift and what can you expect?
What are the possible complications of this procedure?
What should you expect during recovery?
How long can I expect the results to last?
What are the costs?

 Indications: The brow lift procedure centers around correcting three problems.

• Lateral fullness of the upper eyelid and lower brow; common complaint from patients: looking tired. This is caused by gravitational descent of the forehead and brow skin over the orbital bony rim.

• Frown lines are caused by contraction of the corrugator muscles between the eyebrows, over the bridge or root of the nose.

• Transverse forehead wrinkles are caused by muscle activity in raising or lowering the eyebrows themselves.

Note:

Elevation of the lateral forehead [brow lift] will diminish crow’s feet but will not eliminate them; the cause of crow’s feet is squinting, and wrinkling of the skin which the brow lift itself will not address. Please refer to the Botox section for a more thorough discussion of crow’s feet and its treatment.

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The usual age range for brow lift candidates starts in the early-to-mid-40s; however subtle endoscopic techniques have been performed on patients in their late 30’s (exceptional circumstances, in my opinion). Most patients who are 50 years of age or older and who have never had a brow lift are generally good candidates, although I do not strictly adhere to a chronological age indication; physiological aging is the true indication.

Goals: Subtly elevating the brow

Never over-estimate the level of elevation: When the average patient looks in the mirror, they’ll usually pay particular attention to how much brow elevation they think is necessary to create a more youthful and refreshed appearance. But the reality of the matter? The average patient can only see less than 1 cm…approximately 1/3 of an inch…at most. In most cases, even less elevation is actually needed.

My goal on any face lifting procedure is to avoid an “operated” look. I take special care to avoid elevating the brow too much. I’d rather mildly under-elevate the brow than over-elevate it which creates a “startled” look. The brow eventually descends in all cases; fear of “the startled look” causes many patients to avoid exploring a brow lift altogether. This is an over-reaction…when done properly, brow lifting is one of the most gratifying and rewarding procedures that I perform.

The second goal is to soften the wrinkles of the forehead frown lines. There is a popular focus of Internet-fueled debate between plastic surgeons’ offices about the best approach of brow lifting. It’s a “much easier sell” to patients to propose an endoscopic brow lift by claiming smaller incisions, etc. While I perform endoscopic brow lifts (they’re certainly a regular procedure in my “bag of plastic surgeon tricks”), I usually reserve this technique for younger patients without significant transverse and frown lines. It’s rare to find patients whose these lines can be eliminated with the efficiency that can be done through an “open brow” approach. Most of my patients want a permanent resolution to these frown line problems, something I can just about always guarantee for patients undergoing an open brow lifting technique.

The pros and cons of limited incision endoscopic brow lifting vs. an open approach (with a more extensive incision in the scalp) will be thoroughly discussed during our consultation. In the mean time, I’m hoping this cursory on-line overview will suffice. Patients that desire long-term resolution of forehead lines need to question the value of an endoscopic approach. I’m still somewhat leery when it comes to how long a brow lift elevation will last if the support only comes endoscopically through two points of incision.

These points are typically held in place through screws placed in the skull. An open approach will suspend the brow over the entire length of the scalp and (in my hands) will give more longevity to the result. I encourage patients to look at longer-term results from brow lifting procedures. Many of my nursing staff and team members in my office have had brow lifts performed…and you’re welcome to check my work when you’re in the office for your consultation.

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Technical highlights:

As described above, there are two types of (typical) brow lifts: endoscopic and open.

The endoscopic approach can be done by itself or in conjunction with face lifting procedures. Multiple small incisions are made on the scalp and the muscles are removed (partially by forceps) when being viewed by the endoscope. This minimizes the incision and maximizes the preservation of sensation…but a loss of sensation from the brow lift is still possible when utilizing the endoscopic brow lift procedure. The brow suspension is carried out by securing the deep fascia layer (the layer that surrounds the muscle) and is secured typically to a small screw secured in the skull above the lateral eyebrow behind the scalp. This achieves a nice result in young patients who need just subtle elevation and have very little vertical/horizontal forehead lines.

The open approach typically extends the face-lift incisions to connect over the scalp. This fact--in and of itself--causes concern for some women, since it frequently results in a more predictable numbness that can last for approximately one year. This small strip of numbness is posterior (or behind) the incision, covering an area approximately 1-2" wide. This is the one disadvantage in the open brow technique; but in my opinion the advantages (and according to the overwhelming majority of my patients) far outweigh this potential downside. A predictable and consistent resolution in the forehead and frown lines can be assured.

Ninety percent of the muscle activity and wrinkles can be eliminated on a prolonged--if not permanent—basis, but it can’t be achieved through an endoscopic brow lift in most patients. The open approach can also be varied for the person with a high forehead, since the incision can be extended to the frontal hairline. The incisions are excellent…and I’m happy to refer you to photographs on this web site or at the time of consultation. Since an endoscopic brow lift approach also elevates the forehead line, it’s a very unattractive option for patients with high foreheads. (Worth noting: 40-50% of patients have high or marginally-high foreheads, so I’ll routinely use hairline incisions to optimize results.) In many patients we’ll even see a mild decrease in forehead height, which isn’t guaranteed, but can be a nice improvement for many patients.

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Complications:

• Numbness: The primary complication of brow lifting includes numbness. In an open approach, numbness behind the incision will occur for approximately 12 months and, in rare instances, last as long as two years. There is some temporary numbness of the forehead itself, which can last several weeks to several months.

• Itching: When the feeling comes back in the forehead (in most instances), itching is a healthy sign and indicative that feeling and blood supply are returning to normal. In rare instances when the itching is excessively irritating, patients may require Benadryl or similar medication to help relieve the itching (which is very difficult to scratch away). The bottom line? I’ve treated less than 10 patients in all my years of practice for this post-surgical challenge.

• Hair loss: Hair loss along the incision is temporary and is usually not severe. Some patients describe diffuse hair loss in front of the incision. Over the years I’ve been unable to notice hair loss in all but a couple of patients…and it’s returned for all my patients (to the best of my knowledge).

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General Complications:

General complications include infection and bleeding, which are not a common problem with brow lifting.

Recovery:

All information below is based on an average patient, including two standard deviations (95 % of all patients). Some patients fall outside these descriptions and will have a better or worse recovery than the average patient, for unexplained reasons.

Pain - Pain is typically not a significant problem in brow lifts. There is, however, some discomfort and tightness from ear to ear across the top of their head and across the brow.
Drains - Drains are usually not needed in the brow area when doing a brow lift or even when used in combination with brow and face-lift.

Swelling - Maximum swelling occurs 48-72 hours post-surgery and begins to subside on the fourth or fifth post-operative day.

Bruising – Interestingly, bruising on a brow lift appears in the most dependent areas. As a result, any bleeding usually collects below the eyelids and bruises the lower lids…even if the lower lids are not operated upon. Bruising is usually maximized on the third to fifth day and resolves over 2-3 weeks.

Driving - You can resume driving when you are able to drive at the same level you were able to drive at pre-operatively…and this is your call. You’ve got to be able to brake and respond quickly, as well as quickly and easily turn to eliminate your blind spot. When these conditions are met you may resume driving…typically the second or third week post-surgery.

Social return - Most patients feel very comfortable in returning to work (physically, anyway) a few days after an isolated brow lift. But socially is a different matter…and you might have to keep your dance card clear for 2-3 weeks.

The average patient can return to work within 10 days, with the help of a little make-up. There may be some (mild) residual bruising. If bruising is minimal, the return to work can be even earlier.

Numbness - Sensory nerves run close to and within the muscular layer that’s eliminated during a brow lift. As a result, some partial numbness may be present for several weeks post-surgery. Total numbness behind the incision in an open brow lift--whether in the hairline or a standard incision is done--will usually be present for 9-12 months post-surgery…slightly longer in rare instances.

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How long will the results last?

My goal in brow lifting is to give a permanent improvement in the transverse lines and frown lines. Gravity will take its toll as aging continues, but portions of the brow lift (with regard to the wrinkle lines in the brow and the frown line area) should never be as severe again and may return only mildly over the years. However, once the brow is elevated it will continue to descend each year, since gravity continues to (naturally) take hold of the tissue. The average brow elevation patient can expect the effects of the procedure to visibly last at least 6-10 years (on average). However, when this procedure is coupled with the long-lasting effect of elimination of forehead and frown line wrinkles, the longevity of the brow life appears to be (overall) extremely long lasting.

Cost?

We do not feel that it would be appropriate or ethical to post prices for procedures on the internet. We do, however, understand that cost is a factor you must consider. We would be happy to speak with you about this issue so that you may determine whether the procedure you are considering falls within your budget. Our pricing structure is based on the time, complexity, and surgical costs involved. Please feel free to call our office at 214-823-1978 and speak with either Kurthene or Annette for more details.