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The forehead-brow lift operation can be performed alone, with eyelid surgery, or with a facelift. The forehead-brow lift is an important component of facial rejuvenation procedures in most individuals over the age of 50. The operation is designed to correct sagging eyebrows, to lift heavy brow skin that hoods the upper eyelids, and to correct the deep wrinkles between the eyes and on the forehead. It can also be very beneficial in younger patients who have congenital or early descent of the brows. It may also be an essential component of operations to correct the upper eyelids since a significant portion of upper lid complaints may be due to the heavy brow skin that has descended onto the upper lid, a problem not correctable by operation on the upper lids alone.
If fingers on the forehead gently pulling the eyebrows up corrects the heaviness in the upper lids and provides a more youthful appearance, the patient is likely a candidate for a brow lift. In the glabella (between the eyes) the deep vertical creases are caused by the corrugator muscles and transverse wrinkles are caused by the procerus muscle. The transverse creases in the forehead are caused by the frontalis muscle. Long term activity leads to deep wrinkles that are always present. These muscles can be treated with Botox® but are best addressed by muscle division during the operation.
Your procedure
The brow lift is an outpatient procedure which can be done with intravenous sedation and local anesthetic or general anesthesia. In an open brow lift, the incision typically extends from the top of one ear across the hair-bearing scalp to the top of the opposite ear. Hair will mask the scar but the hairline is elevated and hair loss may occur, temporarily or permanently.
In male patients with thinning hair and in patients of either sex with high foreheads, the incisions can be modified to the junction of the hair-bearing scalp and forehead skin. This prevents pulling the hairline back but a fine scar may be visible, especially if the patient later wears their hair back or suffers hair loss. If a facelift is also being performed, the incisions are designed to join. In male patients without a hairline, direct excision of skin above the eyebrows or in a wrinkle can be completed.
In a brow lift, an incision in the lateral brow allows for release of the attachments of the brow, removal of undesired muscle, and limited removal of skin. In an endoscopic technique, 3- 5 small incisions are used to insert instruments and a camera to complete the dissection. After the incision is made by one of the previously discussed approaches, the brow is detached from its insertion to the orbit, the corrugator and procerus muscles are almost completely removed, which should permanently correct the wrinkles of the glabella and remove the opposing force of the frontalis muscle which treats transverse forehead wrinkles. Additional strips of frontalis muscle can be removed or disrupted to further treat forehead creases. The forehead skin is then redraped and traction on the scalp and forehead flap will set the desired position of the eyebrows. Suspension rather than skin excision is key in the endoscopic and mini brow lift and is completed with sutures, screws, or absorbable tines. A forehead lift takes approximately 1 - 2 hours.
Recovery
Following brow lift, the head will usually be dressed with a circumferential dressing for 24 to 48 hours. Pain and discomfort is usually readily controlled with prescribed pain medication. Generally, the swelling will begin to resolve after 3 to 4 days and should not be perceptible to other people after a week to 10 days. It is common to develop a fair amount of bruising around the eyelids or mid face, even when the eyelids are not part of the operation, due to gravity and the laxity of eyelid skin. The stitches or staples are usually removed by the end of the second postoperative week. Activities should be limited for several weeks. Numbness may be present postoperatively but is usually temporary. Thinning of the hair near the incision may occur due to stress on the hair follicles and is almost always temporary.
All of the descriptions for the various procedures are condensed from the text of the upcoming textbook written by Dr. Christopher Park and Dr. Malcolm Marks and are copyrighted, "The Artistry of Plastic Surgery: Exploring the Experience” . |
