“I feel really, really fantastic. Everyone stops and says, ‘Oh my gosh, you look so amazing, so rested!’ But they can’t put their finger on it… I’m loving every second of it!”
– Megan, a 37 year old patient of Dr. Armstrong
If you feel like your eyes look heavy or tired, it may be due to sagging brows. A brow lift will help your eyes appear more open, reduce the appearance of excess skin on your upper lids, and smooth out wrinkles on your forehead.
In a traditional forehead lift, the surgeon tightens the forehead and lifts the eyebrows by removing a strip of skin at the top of the forehead or within the hairline. Placement of the incision is determined by the height of your existing forehead. If you have a short forehead with a low hairline, then the incision can be camouflaged within the hair bearing scalp across the top of your head. This is a very traditional procedure called a coronal forehead lift and probably describes the surgery that most people envision when they think of a forehead lift. For patients with a normal to high hairline, the incision can also be placed just inside the hairline at the top of the forehead. This is called a pre-tricheal skin excision, because it is placed “before the hair.” With careful technique, the surgeon can cut and sew the tissue so that the first few hairs grow through the scar. It is also called a trichophytic incision, which means that the incision is designed at an angle to preserve the hair follicles. With good technique and successful healing, you can likely comb your hair back several months after surgery with minimal visibility of the scar.
The principal advantage – it requires no special equipment and can even be performed under local anesthesia in the office.
The primary disadvantage – the long horizontal incision predictably causes numbness in the scalp behind the incision. This numbness may be permanent.
In an endoscopic forehead lift, the surgeon elevates and smooths the forehead through four tiny incisions in the scalp, using an endoscopic camera rather than direct vision. The endoscopic technique smooths the forehead and raises the eyebrows with the least visible scarring. The incisions are completely behind the natural hairline. The surgeon elevates (loosens) the skin of the forehead and the scalp from the bone using small instruments and a video camera passed through one or more of these incisions. The forehead is pulled upward and secured in the new position. Small sutures or surgical staples are used to close the incisions.
The principal advantage –
- Ability to hide all of the incisions inside the hair
- All incisions are parallel to the sensory nerves in the scalp, which greatly reduces the risk of postoperative numbness in the scalp
- On some occasions, can also assist with lifting the cheeks
- Horizontal wrinkles are reduced by stretching the forehead from above
The primary disadvantage –
- If you already have a receding hairline, this procedure will lift it even farther back
If you can improve the appearance of your upper eyelids or eyebrows by lifting your forehead with your hand, then you would probably benefit from a forehead or brow lift. Place the palm of your hand and four fingers across your forehead, about a finger breadth above your eyebrows. While looking in the mirror, firmly raise your forehead and then release, to observe the difference. Does this reduce the appearance of excess skin in the upper eyelids? If it does, then you may wish to consider a brow lift. Look again at your upper eyelids with the brow elevated. Do you still have excess skin in the upper lids? Does any part of your eyelid block your vision? If so, you may wish to discuss a blepharoplasty (upper eyelid surgery) with your doctor as well. A brow lift is commonly recommended for patients who request upper eyelid surgery.
This procedure is performed on patients in their thirties through eighties. There is no ideal in a Brow lift – skin type, ethnic background, degree of skin elasticity, individual healing, basic bone structure, as well as a realistic attitude are factors that should be discussed prior to surgery.
Depending on the extent of the surgery, the process can take anywhere from 2 to 4 hours.
We can either perform the procedure in-office under local anesthesia with an accompanying oral sedative or the procedure can be performed under general anesthesia at Stony Point Surgery Center (depending on patient preference).
Medicare and most commercial insurance plans will cover a brow lift only if medically necessary to restore vision. If your eyebrows are so heavy that you cannot see above the horizon without struggling to hold your eyes open, then insurance is likely to pay for your surgery.
In addition to a consultation with a facial plastic surgeon, you should also schedule an appointment with your ophthalmologist, who will measure your peripheral vision. This is called a visual field test. By examining the visual field test and by carefully examining your eyes, the ophthalmologist will determine whether the obstructed vision is due to sagging eyelids, eyebrows, or due to a disease within the eye, such as glaucoma.
For younger individuals, the eyebrows can be temporarily improved with Botox (botulinum toxin), fillers, & skin care. If Botox is placed in specific locations, it may temporarily relax muscles and in turn allows eyebrows to pleasantly drift upward. This is referred to as a chemical brow lift. Botox may also be used to flatten the horizontal lines in your forehead. However, you must discuss this carefully with your surgeon, as relaxation of the forehead muscles may reduce your ability to lift the eyebrows, and even cause them to sag.
Risks of Brow Lift
Soreness and Bruising is expected for 2-3 weeks.
Numbness above the hairline may last for months.
Scars will be placed as discretely as possible.
Hair loss may occur at the incision sites.
Paralysis of the forehead, infection, or vision loss are rare.
Anesthesia in an otherwise healthy individual has risks comparable to those of operating an automobile.
Before your Surgery
Things you may need:
- Comfortable button-down or zippered shirts
- Non-irritating baby shampoo & body soap
- Prescription pain medication (if prescribed)
- Bendable straws, disposable dishes, & microwavable meals
- Ready to eat, healthy snacks (low sodium & high fiber to reduce additional swelling or constipation due to pain medications)
Prepare a designated resting-space where you can spend your first few days of recovery. Here are some items to include:
- A comfortable chair that can recline
- Clear path to the bathroom
- TV, laptop, or audiobook for entertainment
Additional actions to take in preparing for your recovery:
- Stock your fridge & finish all laundry
- Place all food items, toiletries, clothes, etc. above waist level to prevent the need to bend over
- Check your calendar
- Pay your bills
- Get someone to help with pets or children
The person who will care for you during the initial recovery period should be able to do the following:
- Read, write, and follow instructions
- Safely drive
- Help with physical task(s)
- Provide emotional support if needed
Things to organize for your caregiver prior to surgery:
- Important contact numbers – close family, medical provider(s), & employer
- Pharmacy address of choice
- Location of prescriptions, ice packs, dressings, or other recovery materials
- Instructions from surgeon
- Any specific home care related instructions (alarm code, pet’s schedule, etc.)
Avoid using any agent that may induce bleeding or bruising beginning 1 week prior to treatment (unless medically necessary).
Arrange to bring a designated driver to your appointment as rebound swelling might affect your vision.
Avoid getting a haircut since longer hair will provide better camouflage in the early post-operative period.
Day of Surgery
Getting ready tips – Shower the morning of your procedure and wash your hair twice. Do not wear any earrings. Make sure your face is clean and completely free of any makeup. Wear a comfortable top that is easy to wash & that doesn’t need to be removed over the head.
Arrive as instructed by SPSC for procedures that will take place in the operating room.
Your designated driver must arrive to the facility with you for check-in process.
After your Surgery
Things to Remember
Keep head elevated as much as possible to minimize swelling.
Wash hair with non-irritating shampoo (Ex. baby shampoo).
Avoid hair styling products until staples or sutures have been removed.
Opt for cold or lukewarm water when cleaning & lower heat hair dryer setting.
Avoid the following until skin has fully healed – hot water, pools, excessive perspiration, & strenuous exercise.
Acetaminophen or Ibuprofen for discomfort.
Fever, Chills, Blistering, oozing, yellow/cloudy drainage, or pain that is not relieved by Acetaminophen are not expected & need to be addressed.
- Expect the following – moderate pain, swelling, numbness, tingling, & bruising (especially around the eyes)
- Keep head elevated & use cold compresses
- You will need the support of friends or family to care for you on the first night
- Do not drive for the first 48 hours
- Stay on top of your pain medication schedule to effectively manage discomfort
Days 1 to 3
- Feel free to perform light walking
- Use a cool compress if needed and avoid the application of heat
- May resume sedentary work on day 3 if needed
- May apply makeup on areas that do not have staples or sutures
Days 4 to 6
- Peak of swelling and residual bruising
- Sutures and staples removed
- May resume high impact aerobic activity or weightlifting
- Most patients return back to work by this time period
Week 3 to 5
- Most swelling & bruising will have dissipated by this time
Week 6 to 8
- Final results will become more evident as things start to “settle-in”
Month 3 to 6
- Scars will be red and slowly start to fade with time
- Limited hair loss may occur near incision and last up to 6 months
- As hair re-grows, incision should become nearly invisible