The primary purpose of brow lifting is to restore a youthful look to the upper face. This goal is accomplished by repositioning the brow and eyebrows and by smoothing wrinkles in the brow skin. In aging, the brow, especially the lateral aspect, descends towards the upper eyelid, making the eyelid seem to disappear. Lines or furrows in the brow, both horizontal and vertical, also develop with aging and overuse of the brow muscles. Brow lift is also helpful to diminish the appearance of “crows’ feet”.
The surgical technique of brow lifting can vary according to the patient’s individual problem and goals. Whether a brow lift is done with or without an endoscope is not an important question. Getting the right result with minimal risk is the key point. During a brow lift it is also possible to surgically reduce the brow muscle activity if desired (a permanent alternative to Botox).
The most common brow lifting technique I perform is a “temporal brow lift”. It is done in the hospital or surgical center, typically with conscious sedation and local anesthesia (the patient is awake, but sleepy). No hair is shaved. Through 4-5 centimeter incisions behind the hairline on each side of the scalp, a dissection is done to separate the skin and frontalis muscle from the deeper tissue layer, thus avoiding a key branch of the facial motor nerve and avoiding blood vessels. The brow, particularly its lateral aspect, is freed from deeper attachments and repositioned. A small excision of excessscalp helps maintain the elevation after careful, layered closure with sutures. Drains are not needed and a head dressing is applied for 48 hours. The surgery takes about 1 hour. There is visible but modest swelling for 3-5 days and possible discoloration of the upper lids. Most patients are ready for social engagements after a week. There is some discomfort, although most patients do not require any narcotic beyond 48 hours, if at all. The incisions are kept well hidden behind the hairline and scarring is a very rare issue. Return to usual hair treatments (besides shampooing) is delayed for 3 weeksto protect the incisions.
Brow lifting can of course be combined with blepharoplasty and facelifting, or be done solo. It is what I call a “stealth” procedure because it provides a powerful rejuvenation but with a rapid, undetectable recovery.