Brow features and contour give distinctive expressions and may produce a “sad”, “mad”, or “surprised” appearance. When drooping occurs, the brow and subcutaneous brow fat pad add weight and heaviness to the upper eyelids and in severe cases the brow can be all the way down on the eyelid. Hereditary features also contribute to this heaviness, particularly if there is a natural hooding of the eyelid folds. Drooping of the brow and the brow fat pad extending below the orbital rim is called “brow ptosis” which is corrected by a brow lift. The brows may be lifted without producing a surprised appearance. Discussion prior to surgery includes desired shape and position of the brow so that your cosmetic goals are achieved.
Direct Brow Lift Before and After Photographs
Direct Brow Lift and Blepharoplasty, before and after – note the downward slant of the eyebrows in the left photo.
Before & After – Direct Brow Lift and Blepharoplasty – a small lateral brow lift elevated the lateral brow cilia.
Direct Brow Lift, Right Upper Eyelid Blepharoplasty, Left Upper Eyelid Ptosis Repair, before and after. One can see a brighter and more youthful appearance achieved.
Before & After Direct Brow Lift, History of Blepharopalsty years ago. Repeat blepharoplasty would pull the brows down onto the eyelids creating an unacceptable appearance. A brow lift eliminates the heaviness of the lid fold seen on the left photograph. The contour flattens as the swelling resolves.
Side View of Brow Lift Incision Line. The mild erythema of the incision lines will resolve over the next 2-4 months.
Other Options for brow lifting:
Many procedures exist to elevate the brows – all with advantages and disadvantages. The direct approach has received bad press on the internet in favor of approaches that are distant from the brow and involve more extensive dissection. The latter methods involve more down time and healing because of the scope of dissection. Patients contemplating brow lift need to objectively consider all approaches and be aware of the risks and benefits of each.
- The coronal approach involves an incision behind the hairline with removal of hair-bearing scalp – a disadvantage.
- A hairline or pretrichial approach may work well with a high forehead but risks loss of sensation in the scalp and creates a long incision along the hairline.
- The endoscopic approach used by some surgeons, involves incisions behind the hairline. Sutures, tacks, or tynes in the outer table of the bone support the forehead and brows. This technique does not remove tissue, and therefore is subject to dropping with time.
- Similar in concept, a thread or suture lift supports the tissue on synthetic material some designed with barbs to hold the tissues.
- A mid-forehead approach places the incision in a forehead wrinkle and may be appropriate in some men, but leaves a long incision line, visible for months.
- The direct brow lift incision is placed parallel to the upper edge of the brow and relies on the brow hair to project upward and cover the incision line as it heals. The direct brow lift is performed in selected locations medial, central, or lateral to correct specific areas of drooping. Because of this, the shape of the brow can be controlled very precisely. Recovery is much quicker and easier for patients than the more extensive options listed above.
It is intuitive that those procedures which remove tissue provide the greatest duration of effect. The remaining tissue could thin and slide over another decade, but the removed skin does not regenerate! Contrast this with the endoscopic technique which does not remove tissue. Those procedures involving removal of tissue seldom have to be repeated, but touch-up surgery can be performed later if desired.
What to expect:
Direct brow lift can be performed in the office if you are healthy – or it can be done in an ambulatory surgery setting if there are health issues or if greater sedation is desired. We offer oral sedation for relaxation in the office setting. Once the local anesthetic is in place, you will not feel pain or discomfort. You may be aware of pressure, gentle movement or tugging. Immediately after the procedure, there is a tight sensation that will resolve over time. There may be tenderness to touch and a bruised feeling as the local anesthetic wears off. Over-the-counter medications for pain generally work quite well, but a prescription for pain medication may be provided. At the post-operative visit, most patients report either no pain or minimal discomfort.
Cold compresses for two days will speed up the resolution of bruising and swelling. The incision will fade with time, but generally in the thicker skin of the brow area, the pink of the incision line stays longer than an eyelid incision which is in much thinner skin. In some patients with pink tones in their skin, the incision fades by 2 months – in others, up to 6-12 months. If you are fortunate to have thick eyebrows, the incision may not show. If the eyebrows are sparse and fair, then makeup or bangs may hide the incision lines until they disappear. Other techniques to accelerate or disguise the fading incision include laser therapy or – in women – micropigmentation.