A brow lift is an operation that lifts eyebrows that have descended with ageing to a higher more youthful position. A brow lift will also improve excess skin in the upper eyelids and may obviate the need for blepharoplasty. However, many individuals require the procedure to be combined with upper eyelid blepharoplasty for optimal aesthetic results. Similarly, for overall facial balance and rejuvenation, the brow lift is commonly combined with face lifting procedures. In the past, the brow lift was performed as an open procedure with an incision across the top of the scalp (coronal brow lift). This method is rarely used nowadays. More commonly used methods include “melon slice’ skin excisions above the eyebrows, temporal lift (affects mostly the lateral third of the eyebrow), trans-blepharoplasty browlift, direct excision of skin at the junction of the forehead skin and the frontal hairline and the Endoscopic browlift (probably the most common brow lifting technique currently)
What are the other effects of a brow lift?
Apart from lifting the brow and improving the upper eyelids, it may improve the wrinkles on the forehead and the frown lines between the eyebrows at the root of the nose. It does not eliminate them. Botox is the most common way of dealing with this.
What can be achieved?
Use a finger on the forehead to pulls the eyebrow upwards at different positions whilst looking in a mirror. This will give you an idea of what elevation can be achieved. It will also give you a good indication of the position where you would like your eyebrow to be lifted the most.
How is the endoscopic brow lift performed?
I perform the procedure under a general anaesthetic (although some people have performed it under local anaesthetic and sedation). It takes about an hour and usually an overnight stay, although you may be able to go home the same day. Small incisions are made within the hairline.
The covering of the bone (periosteum) is lifted off the bone down to the eyebrow. Using the Endoscope, the periosteum is then detached from the orbital rim (the margin of the eye socket) and released from the overlying fat.
The muscles causing the frown lines are partially removed and the brow is elevated and fixed at its new higher position. There are several ways of fixing the covering of the bone back. I will either use a bone anchor or pass a non-absorbable suture through the bone. Absorbable sutures are used to close the small incisions. There are no dressings.
What do you expect after the operation?
There will be tightness in your forehead area. Your forehead may also look and feel smoother than what the final outcome will be.
There may be bruising which because of gravity may involve the lower eyelids and sometimes only the lower eyelids. All of this usually settles in a few weeks.
In many Individuals there is remarkably minimal swelling and bruising after this operation thereby necessitating only a few days to a few weeks off work.
There may be minor degrees of asymmetry.
The bony anchors can be felt underneath the scalp behind the hairline. They take 9-12 months to dissolve completely.
What are the possible complications?
There may be significant headache, which fortunately does not last for more than a day or two. This is due to stretching of the nerves, which go upwards from the eye socket to supply feeling to the scalp.
Rarely these nerves may be permanently injured with resultant loss of feeling over some areas of the forehead and scalp. Also, rarely the branch of the facial nerve that helps you move your eyebrows upwards can be injured.
Occasionally, the bony anchor comes off the bone and needs to be reattached.
Infection is possible but rare.
How long do the results last?
Experience gathered over past 10-20 years on this rather recent procedure shows that the results do last for many years but partial or complete recurrence of brow ptosis can occur.