Often overlooked by patients, the position of the eyebrows is an extremely important part of the facial appearance. Over time, the brows tend to drop, and this can create a tired look. This can also affected the eyelids by causing the upper eyelids to hang over the eyelashes or cause “hooding” of excess eyelid skin. While many patients think that eyelid surgery is the solution to their problems, a brow lift may be needed instead (or in addition to) eyelid surgery to help support the brows. A brow lift might also be called a forehead lift or forehead rejuvenation.
What is a brow lift?
A brow lift is surgical procedure designed to lift and support the eyebrows and surrounding soft tissue. This can help to alleviate heaviness of the upper eyelid areas and is commonly performed for both men and women as part of facial rejuvenation procedures.
How is a brow lift performed? What happens during a brow lift?
In a brow lift surgery, the skin and soft tissue layers (muscle and fascia mostly) are elevated and freed up from the underlying bone of the forehead and temple areas. This tissue is then lifted into a higher, more youthful position and secured in a higher position so that it will heal in that position permanently. There are various fixation techniques that are used to secure the forehead and scalp tissue in a higher position, including Endotine devices, screws, sutures, staples, etc. In our practice, we use a suture technique that avoids any drilling into the skull like many types of anchoring devices require. Any excess skin is trimmed away, and incisions are closed. A dressing is applied which is generally kept in place overnight and removed in our office the next morning.
Is a brow lift painful? How painful is a forehead lift?
Dr. Richardson and Dr. Cain perform brow lifting techniques under deep IV sedation administered by a board-certified anesthesiologist, so this eliminates any discomfort during the procedure. After the procedure, some patients will report a sensation of the scalp and forehead area feeling tight or swollen, but pain is usually minimal. Some patients will report a headache for the first few hours after the procedure, which can be controlled with pain medication if needed. In almost all cases, the pain is gone by the next morning after surgery, and patients report very little pain overall.
What can I expect after a brow lift? What is a brow lift recovery like?
Brow lift recovery is really fairly simple. As described above, patients can experience some mild discomfort for the first day or two after the procedure, but pain is generally very mild overall. Bruising and swelling is quite common, and bruising usually settles more around and under the eyes rather than in the forehead or brow area. This bruising will usually take 1-2 weeks to resolve. Any sutures or staples in the scalp will come out at around 1 week after surgery, while any sutures under the skin will stay in place to hold the forehead and brows in place while they heal in the new position. Swelling and bruising will usually peak around the 3rd day after surgery and then begin to slowly but steadily improve.
Our patients are instructed to avoid getting any incisions wet for 24 hours after surgery, and then to begin washing the hair gently with baby shampoo after 24 hours. They are also instructed to avoid any strenuous physical activity like working out, running, playing sports, etc for at least two weeks after surgery and then to ease slowly back into physical exercise. Patients are generally given prescriptions for antibiotics to prevent infection, steroid medication to help with swelling, and pain medication to use as needed. Minimal wound care is involved, which will usually consist of applying antibiotic ointment to any incisions several times per day.
What are the different types of brow lifts? What is the best brow lift technique?
There is no one best brow lift technique. Brow lifts can be performed several different ways. In addition to open surgical techniques such as trichophytic brow lifts, coronal brow lifts, direct brow lifts, or mid-forehead brow lifts, Dr. Richardson and Dr. Cain are experts in endoscopic brow lifting. This procedure is performed using several very small incisions that are hidden within the hair. Using small endoscopes, the brow is then brought into a more youthful position. In some patients, an endoscopic brow lift may not be indicated or desired, and in these patients, other techniques, such as a coronal or trichophytic brow lift may be used.
The different types of brow lifts that are most common are reviewed briefly below:
- Endoscopic brow lift: With an endoscopic brow lift, small incisions are made within the scalp (hidden in the hair), and a small telescope (endoscope) is inserted under the skin to visualize the surgical field. Instruments are used to lift the soft tissues of the forehead off the underlying bone, and then the brows and forehead are lifted into a higher position. In our practice, we use a specialized suture technique to fixate the brows in this higher position. This is generally combined with a temporal lift where some tissue is removed from incisions hidden within the temporal areas of the hair in order to lift the tails of the brows and temple regions. These incisions within the hair are then closed with staples or sutures which remain in place for one week. No drilling into the bone is required. The downside of this type of lift is that it will lift the hairline slightly higher. The upside is that the incisions are totally hidden within the hair. Because the incisions are shorter, there are generally less issues with numbness of the scalp as well. The corrugator muscles between the brows can be weakened with this technique in order to soften the vertical “11 lines” between the brows, but most patients will still require Botox injections for complete wrinkle reduction in this area even after surgery.
- Trichophytic brow lift: In a trichophytic brow lift, an irregular incision is made directly at the hairline within the first few rows of hair. The forehead is again elevated off the bone and advanced higher in order to lift the brows. The incision is then closed very precisely in order to hide the scar. This incision takes time to fade and for hair to grow up through the incision to help camouflage the scar, which works quite well. The advantage of this technique is that it does NOT raise the hairline, and will actually make the forehead smaller. The disadvantages include increased numbness of the scalp, and a scar that may be partially visible during the initial healing process.
- Coronal brow lift: In a coronal brow lift, the incision is totally hidden within the hair, but is otherwise performed similarly to a trichophytic brow lift as described above. This technique is less commonly performed because the endoscopic technique has mostly replaced the coronal lift, but is still a very effective technique. The coronal brow lift will raise the hairline slightly as well.
- Mid-forehead lift: With a mid-forehead lift, an incision is made within prominent horizontal lines of the forehead, which can hide very nicely in some patients. This is an uncommon technique, but when it is performed, a mid-forehead lift is performed more commonly in males than females due to thicker skin and more prominent horizontal wrinkles in some men. A mid-forehead lift might be able to hide incisions better than other techniques in bald men and can also be relatively effective at improving brow asymmetry.
- Direct brow lift: In a direct brow lift, an incision is made directly within the eyebrow hair itself, at the upper aspect of the brow. The brow is lifted and secured with sutures under the skin, while the incisions are closed meticulously with another layer of fine sutures within the skin as well. This technique is the best at improving brow asymmetry, but scars can be visible in some patients. This technique works best in male patients with bushy eyebrows that help to camouflage the scars.
Can a brow lift correct brow asymmetry? How do I fix my asymmetric brows?
The most common types of brow lifts cannot easily correct brow asymmetry. These most common brow lifts (usually endoscopic and trichophytic techniques in our practice) will generally lift both brows symmetrically. There are some brow lifting techniques such as a direct brow lift that are better at improving brow asymmetry, but these techniques are also worse at hiding scars, and for this reason, are much less commonly performed.
Asymmetric brows are extremely common and do not always need correction. In some cases, neuromodulator injections like Botox or Dysport can be used to improve brow symmetry.
Is a brow lift safe? Is a brow lift safe for all skin types and ethnicities?
Brow lifts are very safe procedures overall. See the risks section below for specific details. Brow lifts are safely performed on patients of all gender, ethnicities, skin colors, etc.
What are the risks of a brow lift? What are the possible complications of a forehead lift?
Every procedure has risks, including both surgical and non-surgical procedures. Risks of brow lifting include bleeding, bruising, swelling, scarring, infection, temporary or permanent nerve injury that could cause numbness or weakness, lack of improvement, need for revision surgery, anesthesia complications, hair loss around incisions, and undesirable cosmetic changes. In general, brow lifting is a very safe procedure with low complication rates and high patient satisfaction rates.
What are the contraindications to a brow lift?
Contraindications to brow lifting include patients with a history of poor wound healing, any bleeding disorders, any active scalp or skin disease in the area, and any general medical issues that would preclude proper anesthesia in a safe manner such as heart disease, lung problems, kidney disorders, etc. Patients with severe dry eye might also be poor candidates for brow lifting due to risks of worsening dry eye symptoms even if only temporary.
How is a brow lift different from a thread lift or a facelift? Is a brow lift part of a facelift?
Many patients are confused about the definition of a facelift and what all is involved. CLICK HERE to read more about facelift procedures. A facelift generally involves lifting the cheeks and neck only. A brow lift is commonly combined with a facelift procedure (and other procedures such as blepharoplasty/eyelid surgery, fat grafting, lip lifting, laser skin resurfacing, etc), but is its own unique procedure. A brow lift is focused on lifting and supporting the brows, not any other areas of the face.
When should you get a brow lift? Am I too young for a brow lift?
Brow lifting is generally performed as part of facial rejuvenation for procedures in patients who are experiencing facial aging, but there are some exceptions. Younger patients with genetic tendencies to have heavy eyebrows, patients with facial paralysis, significant asymmetries, or other issues might also be candidates for brow lifting procedures depending on their anatomy. Dr. Richardson commonly performs brow lifting in conjunction with hairline lowering (forehead reduction surgery) as well. We do not base indications for surgery based on age but instead we focus on the patient’s anatomy and goals.
Are brow lifts only for women? Can men have a forehead lift?
No, brow lifts are commonly indicated for both male and female patients. In some cases, men may have a more difficult time hiding brow lift scars because of thin hair or a receding hair line that might expose scars hidden within the hair. There are many options for male brow lifts, including endoscopic brow lifts, coronal brow lifts, direct brow lifts, and mid-forehead lifts among others.
Who is qualified to perform a brow lift? What type of doctor should I see for a brow lift?
Brow lifts are generally performed by one of three types of surgeons: Facial Plastic Surgeons, general Plastic Surgeons, or Oculoplastic Surgeons. Some Otolaryngologist-Head and Neck Surgeons may also feel comfortable with brow lifting surgery. Other specialties are generally not well-trained in surgical rejuvenation of the face and well-versed in facial rejuvenation. Surgeons performing brow lifting should be board-certified in one of the specialties listed above. Make sure that your surgeon can show you photographs of his or her actual patients who have had various brow lifting techniques performed, including the placement of incisions and scars.
How long does a brow lift last? Is a brow lift permanent?
In many ways, a brow lift is permanent. The aging process continues, so brows may show some increased heaviness over time throughout the years following the procedure, but the brows should always have more support after a brow lift than they would have otherwise had without the procedure.
Will I look different after a brow lift? How do I avoid looking surprised or “over-done” after a brow lift?
We want patients to look like a younger or more refreshed, less tired version of themselves. We are never trying to make patients look like someone other than the best version of themselves. Many patients are afraid of a brow lift as they are worried that they will look surprised or strange. As facial aesthetic experts, Dr. Richardson and Dr. Cain specialize in creating natural, youthful results as seen in the before and after gallery. The key is to choose an experienced, well-trained doctor that can show you before and after images of their own patients, including the location of scars, various types of brow lifts, etc.
How much does a brow lift cost? Is a forehead lift expensive?
Like any surgical procedure, brow lift costs will vary widely between markets and surgeons. Most brow lift procedures will range in price from $4500 – $7500. These costs can also vary based on whether the brow lift is performed as a stand-alone procedure or combined with other procedures like a facelift or blepharoplasty. During your personal consultation with Dr. Richardson or Dr. Cain, we will provide a personalized and detailed quote based on the doctor’s specific recommendations.
The doctors will help you decide which technique may be best for your individual concerns and overall facial anatomy during your consultation.
EMAIL US today or call us at (469) 362-6975 to find out more about how we can help you look your best.
CLICK HERE to see more Brow Lift Before and After Photos