Brow Ptosis & Brow Lift
A forehead lift, or brow lift, is a surgical procedure to improve the appearance of aging associated with the forehead and eyebrows. As we age, our skin looses elasticity and tone which can lead to brow ptosis. Brow ptosis is a low position of the eyebrows that can create a tired or sad appearance. In addition to low brow position, other signs of aging include deep transverse forehead wrinkles and frown lines between the eyebrows.
There are many variations to the brow lift procedure which include the traditional open approach, limited incision or temporal approach, and the endoscopic brow lift. The traditional open or coronal forehead lift involves an incision from ear to ear that is hidden 2-3 inches behind the hairline. For those with receding hairlines or long foreheads, the incision can also be placed at the hairline; this is termed a pretrichial incision. A limited incision or temporal brow lift utilizes shorter incisions that are hidden within the hair, usually slightly above and behind the temple area. An endoscopic brow lift utilizes a lighted camera that can be placed through 3-5 small incisions hidden within the hair. The goal of all of these techniques is to elevate the brow to a more youthful position that will create a more rested or refreshed appearance. In addition to elevating the brow, the upper eyelid area is opened up. This can help improve mild to moderate upper eyelid skin excess, and in severe cases a brow lift can be combined with an upper eyelid tuck (blepharoplasty) if additional skin removal is needed. Frown lines between the eyebrows can also be treated at the time of a forehead lift by removing the muscles responsible for these lines.
Brow lift procedures can be performed in conjunction with other procedures such as upper and lower eyelid tucks to rejuvenate aging eyes and facelifts to rejuvenate the aging face.
After your consultation you should have a clear understanding of the different treatment options for improving the appearance of your forehead and brow. These options may include a traditional open forehead lift, a limited incision or temporal forehead lift, or an endoscopic forehead lift. The procedure may also include treatment of frown lines and/or treatment of excess skin of the upper eyelids. The selection of a specific procedure will be determined by your physical examination and expectations.
During the examination, specific measurements and observations will be made by your plastic surgeon. Brow position in relation to the bony orbit will be evaluated. The effects of your forehead muscle on brow position will also be addressed. Excess skin of the upper eyelids and the position of the upper eyelids in relation to the eye will be measured as well. These measurements and observations along with patient expectations will help determine the appropriate procedure.
Some of the potential risks associated with forehead lifts are areas of permanent numbness of the forehead and scalp, hair loss around the incisions, and asymmetry of the brows.
Following your surgery, bandages and a light wrap will be applied to your forehead. Small drains may be placed temporarily to drain any excess fluid or blood that may collect. You will be given specific instructions on how to care of your incisions and drains, including any medications that you may need to take. The immediate recovery will depend upon what type of anesthesia that your plastic surgeon will employ for the surgery. Various anesthetic agents affect patients differently and will dictate the patient’s recovery. Most surgeons will incorporate extensive local anesthesia into the tissues which can allow patients to wake up pain free. The local anesthesia will begin to wear off in 3-4 hours and most patients will experience mild to moderate discomfort at this stage that is well controlled with pain medication prescribed by your doctor. Patients should avoid strenuous exercise for 3 weeks following surgery. Patients may shower the following day; but no Jacuzzi, swimming or soaking in the tub for a week. Most surgeons want to see their patients back in the office 5-7 days after their surgery to remove the drains which may have been placed at the time of surgery as well as to remove any sutures that do not dissolve on their own. Healing time is highly variable; but most patients experience moderate swelling and some bruising that can persist up to 2 weeks. One of the potential risks of surgery is infection and this usually manifests itself around 5-7 days after surgery and is usually effectively treated with oral antibiotics. Numbness around the incisions is normal after surgery and can persist up to several months.
The actual “full” recovery period from plastic surgery is up to a year and this involves a gradual softening and settling of the scars and tissues. A significant amount of the recovery occurs within 2-3 months, but it will take the external scars a year to soften and mature.