There's More To A Brow Lift Than Meets The Eye
In the realm of facial rejuvenation, brow lifts often take a back seat to more publicized procedures. But in the hands of an experienced plastic surgeon, brow lift surgery can transform the upper face and address visible signs of aging. Brow lift procedures aim to tighten the forehead and elevate part or all of the eyebrows, restoring them to a more youthful position. When properly executed, it brightens up the entire eye area and helps patients to look less “tired,” “grumpy,” or “sad.”
In recent years, plastic surgeons have modernized brow lift techniques to provide more natural-looking results with fewer incisions and less visible scarring. Traditional brow procedures utilized an incision along the hairline from temple to temple, called a coronal brow lift, to elevate the entire brow and often produced that tell-tale surprised look. These days, surgeons instead frequently use endoscopic lifts, performed via small incisions with a tiny camera, which focus mainly on the outer portion of the eyebrow (called a temporal brow lift).
“A small incision hidden in the hairline of each temple provides me all the access I need to correct the sagginess that’s the most common indicator for a brow lift procedure,” says Los Angeles plastic surgeon Jason Roostaeian, MD. In addition to surgically elevating the lateral brow, Dr. Jason uses BOTOX® to smooth out the forehead creases instead of creating additional incisions. “Most of the time,” he says, “it’s just not worth the risk, nor is it necessary, to cut the muscle when we can treat the area with neuromodulators.”
Denice was concerned about her drooping eyelids and sagging jawline and got a comprehensive facial rejuvenation that included a temporal brow lift. “When Dr. Jason suggested a brow lift, I was concerned because I’d heard horror stories about celebrities who ended up looking surprised all the time," she says. "He assured me he wouldn’t do that.” She says that initially, a brow lift “was the least important for me, but it turned out to be the best result. I used to have a very thick furrow in between my brows - that’s gone.”
Because each patient’s anatomy and aesthetic goals are unique, surgeons sometimes still rely on traditional brow lift techniques that have been updated with more modern methods. Farzaneh, another of Dr. Jason’s patients, wasn’t necessarily looking for a brow lift when she made her appointment. “I had a bone cyst on my forehead that I wanted to get rid of, and I also felt like my eyelids were drooping.” During her consultation, Dr. Jason suggested she was a candidate for coronal brow lift surgery, which would address the sagging along the entirety of her brow. Together they decided on a treatment plan that also included a facelift and lower blepharoplasty. The coronal brow lift left a larger scar than other options would have, but at six months post-op, Farzaneh says she uses her hair to conceal her fading scars. “I wouldn’t change anything. Before the surgery, I looked tired and sad and now I look very refreshed. I feel better and more confident."
Philadelphia plastic surgeon Oren Friedman, MD, commonly performs another type of brow lift: the mid-forehead lift. “Mid-forehead brow lifts are primarily performed on men with high hairlines, as the incision hides beautifully in the men’s deep forehead creases," he says. "This is type of brow lift is often performed for cosmetic reasons, but also is frequently used for patients with facial paralysis in which one eyebrow is at a much lower position than the other side.”
John, for instance, suffered from facial paralysis and asymmetry on the left side of his face as a result of a benign tumor removal. To elevate John’s sunken brow, Dr. Friedman performed a mid-forehead brow lift, concealing the incision in his natural forehead lines. “I had creases in my forehead from working in construction," he says. "You have to really look at it to see it’s a scar.” The surgery, along with procedures to help restore his cheek and eyelid function, helped John regain a sense of peace after his ordeal.
As with all cosmetic procedures, it’s best to research and consult with a plastic surgeon who will listen to your particular concerns and formulate a unique treatment plan, rather than approaching a doctor with a specific procedure in mind. "Often, people come in complaining about their droopy eyelids, asking me for upper eyelid surgery, when in fact what they need is a brow lift,” says Dr. Jason. The difference is subtle. “When the eyelid skin is hanging low at the outer edge of the eye, that’s likely an indicator for a brow lift. When it’s sagging more over the eyelashes, that’s when we do the upper blepharoplasty," he says.
When patients seek out a consultation to address a sagging brow or frown lines, it’s not uncommon to find other areas exhibiting age-associated laxity and volume redistribution. Both Dr. Jason and Dr. Friedman frequently perform brow lift surgery in combination with neck and facelifts, which alleviate excess skin in the mid to lower face and jaw areas, as well as with upper and lower blepharoplasty (eyelid lifts). According to Dr. Friedman, “to help create natural appearing results, rejuvenating multiple areas at once is the preferred approach. This way a refreshed brow region blends nicely with the rejuvenated eyelids and face.” Dr. Jason agrees. “With facelifts, we’re moving up the tissue of the lower half of the face. In many patients, I find it best to continue that lift up to the temples, which also helps to conceal some of the scar up along the scalp.”
Brow lift procedures usually take about one to two hours. The type of anesthesia, local or general, largely depends on the patient's comfortability. Dr. Friedman generally recommends local anesthesia with sedation for his endoscopic brow lift surgery, as he finds there is significantly less swelling and more rapid recovery, whereas Dr. Jason typically performs his coronal and temporal lifts under general anesthesia. Patients undergoing only a brow lift can go home the same day; those who combine the surgery with a facelift and/or other surgical procedures are encouraged to stay overnight. At home, patients should diligently follow their plastic surgeon’s instructions, which include washing hair very gently and avoiding strenuous exercise and excessive chewing. To minimize swelling, Dr. Friedman advises patients to get up and out of bed as soon as possible. Dr. Jason suggests patients apply ice water cold compresses for 48-72 hours, keep their head elevated while sleeping for about 2-3 weeks, and stick to a low salt diet for 3 months post-operation. “In most cases, bruising and swelling subside sufficiently within the first few weeks, but can persist for up to 3 months,” says Dr. Jason. Depending upon the surgeon, the technique used, and whether or not it’s combined with other procedures, brow lift surgery ranges from about $4,000 - $12,000.
Complications after brow lift surgery are rare, but in addition to the typical risks associated with anesthesia, can include hematoma (collection of blood underneath the skin), scalp itching, and loss of sensation (which generally returns by one year but may be permanent). “Headaches after brow lift procedures are also quite common,” says Dr. Jason. Besides these medical risks, the biggest danger of undergoing a brow lift is an unsatisfactory result. According to Dr. Jason, “If a person isn’t happy because they feel like their brows are still too low, that’s a relatively simple fix - they can repeat the surgery. But if it’s the opposite - if their surgeon pulled the mid-forehead too tightly and they look surprised all the time - that’s almost impossible to correct. This is why it’s so important for people to seek out board certified plastic surgeons."
“After the brow lift,” says Dr. Friedman, “patients are thrilled to have their eyes revealed - they look younger, happier, and healthier with eyebrows repositioned to their youthful levels.” Dr. Jason agrees: “In the right candidate, a brow lift can have a remarkable effect not only on a patient’s youthful appearance, but on their everyday wellbeing. When you look refreshed, you can’t help but feel that way too.”