A brow lift, or forehead lift, is designed to rejuvenate the area of the eyebrows and forehead. It can be used to address the sagging effects produced by age, gravity and even genetics to produce an improved appearance of energy and vitality. The procedure can help counteract wrinkles, heaviness and eyebrow droop which can result in a tired, sad or aged look.
As with all facial rejuvenation procedures, choosing a Board Certified plastic surgeon who will accurately but conservatively address the forehead and eyebrows is critical to avoid an overstretched, overdone or “surprised” look. Brow lifts are often performed or required for patients that also have drooping upper eyelids or eyelid skin. Heaviness in the eyebrows results in increased laxity and droop in these areas and both must often be addressed together to achieve an excellent result.
The best candidates for forehead lifts
The best candidates for this procedure are in good health and have a realistic expectation of what can and should be achieved. Dr. Granzow believes a conservative approach to this and all other areas of facial surgery is critical, and a goal or expectation of removing every last forehead wrinkle is not realistic or desired.
What is important in a nice forehead lift?
The goal of a good forehead lift is to seek a rejuvenation of the forehead, eyebrow and even upper eyelid area without suffering an “operated look.” Eyebrows that are drooped down or heavy can be brought up into a much more aesthetically pleasingly and anatomically correct position, and upper eyelid surgery can be performed at the same time, or even at a later date, if necessary.
Most forehead lifts can safely and effectively be performed through small incisions that are well hidden in the hairline or even with the use of a surgical device called an endoscope. Despite the hype, the endoscope is useful in some patients but not necessary in all cases. Rarely is a larger incision across the forehead at the hairline required. Again, however, avoidance of an overly aggressive or overly elevated and surprised look is most important.
In addition, muscle in the area over the nose between the eyebrows may also be cut or removed to permanently reduce the wrinkling or furrowing of the eyebrows in this area.
The surgery
A forehead lift is performed under heavy intravenous sedation or, most commonly, general anesthesia in a surgery center or a hospital setting. The patient is comfortably asleep during the entire procedure.
The procedure takes between one and three hours, depending upon the complexity of the individual case.
For most procedures a limited incision is made in the hairline, midway between the ear and the top of the head, about 1-3 cm back from the most forward edge of the hairline. Dr. Granzow uses a carefully angled incision and meticulous closure with absorbable sutures to hide the scar.
Using special surgical instruments, retractors and lights, the skin of the forehead is gently elevated to allow the brows and skin to be more properly positioned in a higher and more anatomic location. During the procedure, the position of the eyebrow may actually be slightly over-corrected as there is always a natural sag and fall with healing after the surgery. Great care must be exercised at this point not to over-position or over-correct the eyebrow.
At this point, the muscle between the eyebrows may be cut or removed to reduce wrinkling in this area as needed and the skin and the forehead musculature and fascia are carefully affixed in their new position.
The skin is meticulously closed in multiple layers, usually with sutures which are self-dissolving.
In some cases, the use of a camera-like device called an endoscope may be required. The incisions for an endoscope are shorter than the normal incision but more such incisions are required. All these incisions also remain in the hairline. Regardless of whether a small incision or an endoscope is used, the actual techniques to fix the brows in the improved position remain relatively the same.
In rare instances, such as in patients with severely receded frontal hairlines or excess skin wrinkling, a wavy incision may be carefully made at or near the front edge of the hairline. This allows more complete removal of a larger amount of wrinkled skin. Again, this is an older procedure and is rarely employed now and only in very specific instances.
What to expect after the surgery
You will experience a certain amount of swelling and bruising the first several days after the surgery. Most swelling and bruising tends to subside and disappear within the first 1-2 weeks. The use of ice and keeping the head in an elevated position after surgery can significantly reduce the amount of swelling experienced.
Risks of the procedure
A brow lift is considered a safe procedure but does carry standard risks. These risks are similar, regardless of which surgeon performs the procedure or in which hospital or surgery center it is performed.
Risks include: bleeding, infection, pain, damaged nerves and vessels, asymmetry, unfavorable healing and scarring, hematoma or fluid collection, transient or permanent nerve or muscle weakness or numbness, correctable hair loss at the incisions, eye irritation or dryness, possible need for revision surgery and the standard risks of anesthesia, including the rare risks of blood clots in the legs or lungs.
Be sure to ask the doctor about any questions or concerns you may have regarding the procedure.
Will my forehead look “frozen” after the surgery?
A brow lift is designed to reposition and replace the eyebrows, skin and musculature of the forehead. Unlike Botox, it is not designed to weaken or paralyze the musculature, and any changes in muscle tension and movement are very unlikely. The exception is if the small muscle between the eyebrows, which causes an unsightly furrowing or creasing between the eyebrows above the nose, is purposely removed by the surgeon after careful consultation with the patient.
Overall, the results of the procedure will be long-lasting and the scars and incisions are typically well-hidden in the hairline and quite minimal.
