A youthful brow at rest is positioned above the orbital rim, with a gradual arch laterally, and the lateral end or ‘tail’ of the brow located higher than the medial end. As one age, it is common for the brow to assume a flat or horizontal position. If a sagging brow inhibits your facial expression, a brow lift is a time-tested method for rejuvenating the upper third of your face.

A brow lift (forehead lift) reverses the effects of gravity and tightens the soft tissues of the forehead to restore a more youthful contour to your forehead skin, upper eyelids and eyebrows. Common reasons for a brow lift include: (1) droopy or lower eyebrow position that creates a tired, sad or grumpy appearance, (2) presence of deep horizontal creases across the forehead, (3) prominent frown lines or furrows between the eyebrows or across the top of your nose resulting in angry expression and (4) excess skin or fatty tissue hanging over the eyes resulting in difficulties in applying makeup for upper eyelid which is commonly seen in females.

Brow lift procedures have evolved from open techniques to more complex short incision or endoscopic techniques. A brow lift usually involves incisions in the hair-bearing scalp, but sometimes incisions are made in the forehead and/or the upper eyelids. The selection of brow lift is based on facial features and aesthetic preferences. The aesthetic goal is to achieve the most beautiful and natural-looking results with smooth and comfortable recovery as possible.

Various types of brow lift procedures:

  • Open (coronal) technique. The incision is across the top of the scalp, beginning above the ears and hidden within the hair.
  • Short or Limited incision technique. The incisions are hidden in the temporal hairline (temples). If the brow lift is done in conjunction with an upper blepharoplasty, upper eyelid incisions will be used to complete the brow lift by treating ‘frown’ lines between the eyebrows and raising the inside part of the eyebrows.
  • Endoscopic brow lift. The incisions may include three short incisions along the top of the scalp and a temple incision on each side. These incisions will be hidden within the hair.
  • Temporal fasciaplasty. Small incisions made at the hair-bearing area of temples to reposition deeper tissues and remove excess scalp tissues. Thus, providing the lift to the lateral portion of the eyebrow and periorbital region.

Facial rejuvenation procedures that are commonly performed in combination with a brow lift include:

  • Blepharoplasty (to rejuvenate ageing periorbital region)
  • Facelift (to rejuvenate the midface, jawline and neck)
  • Fat grafting (to augment soft tissues in the face and periorbital region)
  • Laser skin resurfacing or chemical peel (to improve the skin texture and tone)

Ideal candidates for brow lift

  • The patient who has a positive outlook and realistic expectations in mind for the improvement of the appearance
  • Physically healthy
  • Non-smoker

Preoperative evaluation for brow lift

Communication is vital to achieving the patient’s goals. During the initial consultation, patients will have the opportunity to discuss their goals and desired results with the plastic surgeon. The plastic surgeon will work closely with the patients to reach an agreement about the expectations from the surgical procedures involved and their long term benefits. Every patient is different. Therefore a specific treatment regimen is planned to suit an individual’s need.

The preoperative assessment for brow lift may involve:

  • Discussion about patients’ expectations and desired outcome
  • Medical conditions, drug allergies and previous medical or surgical treatment
  • Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
  • Examination of the face and its soft tissues
  • Discuss the options available for a brow lift and facial rejuvenation
  • Preoperative evaluation for types of anaesthesia
  • Photography for preoperative and postoperative evaluation

Preparation for brow lift

  • Preoperative medical evaluation including blood investigations
  • Avoid certain medications or adjust your current medications
  • Stop smoking or alcohol for about 2-3 weeks before the scheduled surgery
  • Avoid taking aspirin and certain anti-inflammatory drugs and herbal supplements as they can increase bleeding and bruises

The risks and safety information on brow lift

It is essential for patients to understand that every surgical procedure has its complications and downtime. However, if a patient is appropriately assessed before the surgery and postoperative care is given adequately, these risks can be eliminated or reduced. The risks involved in brow lift may vary depending upon the nature of the surgical procedure.

Some of the risks of a brow lift include:

  • Wound infection
  • Poor wound healing (higher risks in chronic smokers)
  • Unfavourable scarring
  • Bleeding (hematoma)
  • Anaesthesia risks
  • Hair loss at the incisions
  • Facial nerve injury
  • Numbness or other changes in skin sensation
  • Fat necrosis
  • Fluid accumulation
  • Skin contour irregularities
  • Skin discolouration, sensitivity or swelling
  • Asymmetry
  • Possibility of revision surgery

Postoperative expectations of brow lift

After the surgery, a compressive dressing may be applied to the forehead to minimise swelling and bruising. If tubes are inserted to drain out fluid or blood from the operative field, they will be removed on the first or second day after the surgery. During the first 1-2 weeks after the surgery, the patient may experience swelling, numbness, discomfort, bruises and discolouration around the forehead and periorbital regions. During the healing phase, the patient may also experience itchiness on the forehead or scalp for some time. These symptoms mentioned are usually transient and will disappear with time. Oral antibiotics and analgesics will be prescribed to reduce the risk of infection and post-operative pain respectively. The stitches will be removed 7-10 days after the surgery.

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Postoperative care for brow lift

  • Follow the postoperative instructions given carefully.
  • Head elevation especially when sleeping for 1-2 weeks.
  • Take the prescribed medications as instructed.
  • Compressive bandage or garment over the forehead may be necessary for 3-5 days after the surgery.
  • Ice compression on the forehead for 3-5 days.
  • Regular wound cleaning with an antiseptic solution and antibiotic ointment.
  • Allow gentle hair washing from second-day post surgery.
  • Avoid strenuous physical activities for 3-4 weeks.
  • Makeup to cover the bruises and discolouration may be allowed from third-day post surgery.
  • Regular use of sunscreen for 3-6 months after the surgery.

How much will a brow lift surgery cost?

Cost is always a consideration in elective surgery. The cost for brow lift can vary widely. Cost may include:

  • Surgeon’s fee
  • Hospital or surgical facility costs
  • Medical tests (blood investigations)
  • Anaesthesia fees
  • Prescriptions for medication
  • Post-surgery garment (forehead compressive garment)

Brow lift surgery is a cosmetic surgical procedure. Therefore, most of the health insurance companies do not cover cosmetic surgeries or their complications.