Brow Lift

“Are you angry and tired of looking angry or tired?”

A forehead lift or “browlift” is a procedure that restores a more youthful, refreshed look to the area above the eyes. The procedure corrects drooping brows and improves the horizontal lines of the forehead and the vertical furrows between the eyebrows that can make a person appear angry, sad or tired.

In a browlift, the muscles and tissues that cause the furrowing or drooping are removed or altered to smooth the forehead, raise the eyebrows and minimize frown lines. Dr. Guy may use the conventional surgical method, in which the incision is hidden just behind the hairline; or it may be performed with the use of an endoscope, a viewing instrument that allows the procedure to be performed with minimal incisions. Both techniques yield similar results — smoother forehead skin and a more animated appearance.  There are several different techniques for brow lifting, some more complicated than others.  After your examination, Dr. Guy will recommend which brow lifting procedure would be best for you and you will mutually make a decision as to which procedure to have done.

A browlift is most commonly performed in the 40-60 age range to minimize the visible effects of aging. However, it can also help people of any age who have developed furrows or frown lines due to stress or muscle activity. Individuals with inherited conditions, such as a low, heavy brow or furrowed lines above the nose can achieve a more alert and refreshed look with this procedure.

The browlift is often performed in conjunction with a facelift to provide a smoother overall look to the face. Eyelid surgery (blepharoplasty) may also be performed at the same time as a forehead lift, especially if a patient has significant skin overhang in the upper eyelids. Sometimes, patients who believe they need upper-eyelid surgery find that a forehead lift better meets their surgical goals.  Some patients have already had eyelid surgery but have hooding of the upper eyelids again, due to sagging of the eyebrows.  The forehead or browlift can rejuvenate the eyelids and lateral eyes again.

Forehead or Browlift Basics

Procedure:
Minimize forehead creases, drooping eyebrows, hooding over eyes, furrowed forehead and frown lines by removing excess tissue, altering muscles and tightening the forehead skin. May be done using the traditional technique, with an incision across the top of the head just behind the hairline or on the edge of the hairline; or with the use of an endoscope, which requires 3 to 5 short incisions. Most often done on people over 40.  Endoscopic brow lifting is usually more appropriate people in their 40’s and 50’s, while the open approach may be needed for older individuals.

Length:
1 to 2 hours.

Anesthesia:
Local with sedation, or general.

In/Outpatient:
Usually outpatient.

Side Effects:
Temporary swelling, numbness, headaches, bruising. Traditional method: Possible itching and hair loss (usually temporary) and prolonged numbness.

Risks:
Injury to facial nerve, causing loss of motion, muscle weakness, or asymmetrical look. Infection. Broad or excessive scarring.

Recovery:

Back to work:
7 to 10 days, usually sooner for endoscopic forehead lift.

More strenuous activity:
several weeks.

Full recovery from bruising:
2 to 3 weeks. Limit sun exposure for several months.

Duration of Results:
Usually 5 to 10 years.

Consultation & Preparation

During your consultation, Dr. Guy will discuss your goals for the surgery and ask you about certain medical conditions that could cause problems during or after the procedure, such as uncontrolled high blood pressure, blood-clotting problems, or the tendency to develop large scars. Be sure to tell Dr. Guy if you have had previous facial surgery, if you smoke, or if you take any drugs or medications — including aspirin or other drugs that affect clotting.

If you decide to proceed with a forehead lift, Dr. Guy will explain the surgical technique, the recommended type of anesthesia, the risks and the costs involved.

Dr. Guy will give you specific instructions to prepare for the procedure, including guidelines on eating and drinking, quitting smoking, and taking and avoiding certain vitamins and medications. Carefully following these instructions will help your surgery and your recovery proceed more smoothly.

If your hair is very short, you may wish to let it grow out before surgery, so that it’s long enough to hide the scars while they heal.
You should arrange for someone to drive you home after your outpatient surgery, and to help you out for a day or two.

The Plastic Surgery

Most forehead lifts are performed under general anesthesia.  Occasionally they may be done with local anesthesia with sedation.  Dr. Guy will help you decide which surgical approach will best achieve your cosmetic goals: the classic or “open” method, or the endoscopic forehead lift. Make sure you understand the technique that Dr. Guy recommends and why she feels it is best for you.

THE CLASSIC FOREHEAD LIFT. Before the operation begins, your hair will be tied with rubber bands on either side of the incision line. Your head will not be shaved, but hair that is growing directly in front of the incision line may need to be trimmed.
For most patients, a coronal incision will be used. It follows a headphone-like pattern, starting at about ear level and running across the top of the forehead and down the other side of the head. The incision is usually made well behind the hairline so that the scar won’t be visible.

If your hairline is high or receding, the incision may be placed just at the hairline, to avoid adding even more height to the forehead. In patients who are bald or losing hair, a mid-scalp incision that follows the natural pattern of the skull bones is sometimes recommended. By wearing your hair down on your forehead, most such scars become relatively inconspicuous. Special planning is sometimes necessary for concealing the scar in male patients, whose hairstyles often don’t lend themselves as well to incision coverage.

If you are bald or have thinning hair, Dr. Guy may recommend a mid-scalp incision, forehead crease incision, upper eyebrow incision or other solutions,

Working through the incision, the skin of the forehead is carefully lifted so that the underlying tissue can be removed and the muscles of the forehead can be altered or released. The eyebrows may also be elevated and excess skin at the incision point will be trimmed away to help create a smoother, more youthful appearance.

The incision is then closed with stitches or clips. Your face and hair will be washed to prevent irritation and the rubber bands will be removed from your hair. Although some plastic surgeons do not use any dressings, Dr. Guy may choose to cover the incision with gauze padding and wrap the head in an elastic bandage.  Often a small drain is used to decrease bruising about the eyebrows or eyelids.  The drain is usually removed the next day in the office.

THE ENDOSCOPIC FOREHEAD LIFT. Typically, an endoscopic forehead lift requires the same preparation steps as the traditional procedure: the hair is tied back and trimmed behind the hairline where the incisions will be made.

However, rather than making one long coronal incision, Dr. Guy will make three, four or five short scalp incisions, each about an inch in length. An endoscope, which is a pencil-like camera device connected to a television monitor, is inserted through one of the incisions, allowing Dr. Guy to have a clear view of the muscles and tissues beneath the skin. Using another instrument inserted through a different incision, the forehead skin is lifted and the muscles and underlying tissues are removed or altered to produce a smoother appearance. The eyebrows may also be lifted and secured into their higher position by sutures beneath the skin’s surface or by temporary fixation screws placed behind the hairline.

When the lift is complete, the scalp incisions will be closed with stitches or clips and the area will be washed. Gauze and an elastic bandage may also be used, depending on Dr. Guy’s preference.

Recovery & Results

The immediate post-operative experience for a patient who has had a classic forehead lift may differ from a patient who had the procedure performed endoscopically.

Forehead lift patients may experience some numbness and temporary discomfort around the incision, which can be controlled with prescription medication. Patients who are prone to headaches may be treated with an additional longer-acting local anesthesia during surgery as a preventive measure.

You may be told to keep your head elevated for two to three days following surgery to keep the swelling down. Swelling may also affect the cheeks and eyes– however, this should begin to disappear in a week or so.

As the nerves heal, numbness on the top of your scalp may be replaced by itching. These sensations may take as long as six months or more to fully disappear. If bandages were used, they will be removed a day or two after surgery. Most stitches or clips will be removed within two weeks, sometimes in two stages.

Some of your hair around the incision may fall out and may temporarily be a bit thinner. Normal growth will usually resume within a few weeks or months.

Although you should be up and about in a day or two, plan on taking it easy for at least the first week after surgery. You should be able to shower and shampoo your hair within two days, or as soon as the bandage is removed. Most patients are back to work or school in a week to 10 days. Endoscopic patients may feel ready to return sooner. Vigorous physical activity should limited for several weeks, including jogging, bending, heavy housework, sex, or any activity that increases your blood pressure. Prolonged exposure to heat or sun should be limited for several months.

Most of the visible signs of surgery should fade completely within about three weeks. Minor swelling and bruising can be concealed with special camouflage makeup. You may feel a bit tired and let down at first, but your energy level will increase as you begin to look and feel better.

Be sure to look at our before and after photos in our website photo gallery.