Brow Lift (Forehead Lift, Browplasty)

A brow lift, which is also known as a forehead lift or browplasty, aims to improve the facial appearance by tightening or getting rid of excess skin and tissues that cause eyebrows to sag. Various types of brow lifts exist, but they all share the same goals: to lift underlying muscles and forehead tissues in a way that lessens wrinkles and deep furrows, which can cause a person to look older and angry.

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Summary

According to The American Society for Aesthetic Plastic Surgery, there were 22,713 brow lift procedures performed in 2017. A qualified board-certified plastic surgeon can help determine the specific type of brow-lift technique that may work best for you to lift your eyebrows from a saggy position, which can at times cover the vision or bring an aged “mean” appearance.

The American Board of Cosmetic Surgery notes that brow lifts affect the area above the brows, while eyelid lifts improve the area around the eyes. Facelifts, on the other hand, focus on the region of the face surrounding the middle or lower portions, while a neck lift improves the collar bone and chin area.

An experienced plastic surgeon will also be able to determine if eyelid surgery would better suit you in lieu of or in addition to a forehead lift, since brow lift surgery won't alleviate the crow's feet type of wrinkles around the eyes or baggy eyelids.

As reported by Johns Hopkins Center for Facial Plastic and Reconstructive Surgery, patients from ages 40 to 60 are the ones most likely to undergo an eyebrow lift.

Types of Brow Lifts

The use of dermal fillers can help fill out and prevent forehead wrinkles, improving the brow area. In combination with fillers, Botox is even used as one of the methods of lifting the brows, as you'll discover in the following sections. However, brow lift surgery can lift the eyebrows, forehead, and upper eyelids in a dramatic fashion that helps frown lines decrease. A cosmetic surgeon who specializes in facial plastic surgery can cause a more youthful appearance and a welcoming facial expression to appear via a brow lift procedure.

Find out next about seven main types of brow lifts, from the traditional and invasive form of cosmetic surgery for the brows to the less invasive endoscopic brow lift and beyond.

#1: Coronal Brow Lift

The coronal brow lift is named as such because "coronal" relates to the "crown" of something - in this case, the head. With a coronal brow lift, which is often called a forehead lift, the long incision site runs from one ear to the other ear across the top of the head, like a headband. The facial plastic surgeon makes the long incision in the portion of the scalp that is hidden by the hair, and the surgical procedure bevels the incision site in an attempt to protect the hair follicles from being harmed.

A refreshed appearance is then created when the brow area is manually lifted along with underlying muscles, and excess skin is removed to create a smoother forehead. Patients who have extremely high foreheads may respond better to an anterior hairline incision site, which allows for a brow lift that doesn't change the hairline height, but may leave more visible scars that can be covered with bangs.

#2: Endoscopic Brow Lift

An endoscopic brow lift usually involves four to six small incisions being placed within the scalp, behind the hairline. The cuts make room for an endoscope to be inserted in order to allow the facial plastic surgeon to see muscles and tissue via the camera attached to the tube-like device. The small incisions also allow space for the muscles to be moved or cut in a manner that provides a forehead and brow lift.

Extraneous fat and tissue can also be extracted during the surgery, while the brows are lifted as well. The endoscopic procedure creates fewer scars than the traditional forehead lift with the long incision, therefore recovery time is shorter. Because of these advantages, the endoscopic lift is the most common form of incision type used during brow lifts.

#3: Pretrichial Brow Lift

A pretrichial brow lift places the incisions along the hairline in the front, or close within the front of the hairline. According to Robert Brobst, MD, a Dallas-based facial plastic surgeon, your pretrichial incision site will be based upon factors such as the shape of your forehead and hairline.

Dr. Brobst urges a pretrichial lift with the incision placed in a short central location, combined with a endoscopic forehead lift, for individuals who have foreheads that are extremely curvy, or for people with high hairlines.

Select surgeries can be performed at the same time. Traditional pretrichial forehead lifts could be done in conjunction with a facelift, and the facelift incision could in fact join the brow lift incision.

#4: Combination Mid-brow Incision with Endoscope Brow Lift

There are times when a combination of techniques works best for specific patients, such as an endoscopic brow lift used in combination with a "mid-brow" incision that is hidden in a forehead crease. As seen in eyebrow plastic surgery photos from the Oxford University Press, arrows are drawn from approximately the middle of the eyebrow traveling upward toward the hairline, to detail the planned incision site.

An endoscope can then be used to view beneath the brow area as the surgeon manipulates the underlying muscle, tissue and fascia as needed. A variety of surgical tools can be utilized to create suspension and trim any excess fat and tissues.

#5: Traditional Mid-brow Lift

Another method of performing a lift from the middle of the eyebrow area is the traditional mid-brow lift, which isn't used as often as an endoscopic lift, but it also creates an incision within the patient's forehead crease. The incision site may help the surgeon precisely target the area for brow lifting and removal of excess skin, but the Williams Plastic Surgery Specialists note that a mid-brow lift creates incisions in a location that is very visible.

Yet and still, the traditional mid-brow lift allows for flaps of skin to be raised to perfect the brow position and to correct crooked or asymmetrical eyebrows.

#6: Direct Brow Lift

A direct brow lift is one of the brow lift techniques that involves incisions directly atop the eyebrow hairs to attempt to hide the scars therein, according to Review of Ophthalmology. The direct brow lift procedure is not as common as it once was, but can still be useful for certain patients who require specific corrections in the functionality of their brow areas.

As reported by the Indian Journal of Plastic Surgery, the direct brow lifting technique can be effective, although it is oftentimes not used because of the potential for visible scars. In general, the direct brow lift is often reserved for older or male patients who have thick bushy eyebrows that can more readily hide the scarring. The study included 50 men who had direct brow lift surgery, along with upper eyelid blepharoplasty surgery.

Overall, the direct brow lift was determined to help brow height asymmetry greatly because of the superior level of control it provided to reverse drooping eyebrows. The results proved that the direct brow lift technique also provided long-term results for bald men and those with high hairlines.

#7: Chemical Brow Lift

A chemical brow lift uses substances like Botox, instead of incisions and sutures, to lift the eyebrows. Botox can be injected into specific areas in order to relax muscles that pull the brows downward. Botox injections can cause the patient to be unable to contract those specific muscles, which in turn can minimize wrinkles.

Shaping the brows with Botox necessitates a deep understanding of how the underlying muscles perform, and can have a limited effect upon raising the brows when compared to surgical methods, according to Young R. Cho, MD, PhD. However, plastic surgeons and expert injectors who specialize in the procedure can use a combination of Botox and dermal fillers to raise and shape the brows in a way that offers a beautiful aesthetic without surgery.

Ideal Candidates for Brow Lifts

The ideal candidates for brow lifts may vary, based upon the type of procedure being considered. In general, potentially good brow lift surgery patients include the following:

  • Overall healthy individuals with brows that sag
  • Folks who dislike how their droopy eyebrows make them appear older, angry or sad
  • People with deep horizontal forehead wrinkles
  • Patients with deep furrows and frown lines between or over the brows or the top of the nose
  • Men or women with excess skin and tissue that hangs over their eyes, blocking their vision
  • Balding men who won't be affected by hairline changes because their hairline has receded
  • Good chemical brow lift candidates are ones who have good skin quality, less laxity and aren't ready for surgery

Who Should Not Get a Brow Lit?

Certain individuals may not be good candidates for brow lift surgery, but consult your physician regarding the following conditions:

  • Patients allergic to general anesthesia, local anesthesia, or any intravenous (IV) sedation that may be used during their procedure
  • Individuals seeking Botox brow lifts that are allergic to the substance, or have droopy eyelids that Botox could worsen
  • Patients seeking to correct sagging forehead skin shouldn't seek correction through a chemical brow lift
  • Individuals with thin hair or those suffering from hair loss shouldn't have the pretrichial brow lift
  • Darker-skinned individuals should be aware that visible scarring may be more evident
  • People with high hairlines or those who are balding should not receive a coronal brow lift and endoscopic brow lift due to the visibility of the scars
  • Patients who don't have deep forehead wrinkles to hide incision sites and those with low front hairlines should not receive a mid-brow lift - along with those concerned about issues with their foreheads and temples

How Much do Brow Lifts Cost?

According to the American Society of Plastic Surgeons, the average cost of a brow lift in 2017 was $3,374. However, that amount does not account for additional costs associated with brow lift surgery, such as the expenses incurred for medical history tests, surgical anesthesia, facility fees for the cost of the operating room, along with other expenses for prescription medication and recovery needs.

Since the types of brow lift surgeries vary widely, along with the fee charged by the facial plastic surgeon based on his or her location and level of experience, brow lift costs can run the gamut. According to RealSelf, brow lift costs can range from $300 up to $14,000. With nearly 500 reviews submitted to the site, the average cost of brow lift surgery is currently listed at $7,150.

Invasive brow lift surgeries such as the coronal, pretrichial, traditional, direct brow lift, and even an endoscopic brow lift can range in cost from $4,000 to $7,000. Certain patients choose to combine their brow lift procedure with additional treatments, such as the individual who reported paying $6,500 for a brow lift, upper eyelid blepharoplasty, and laser skin resurfacing.

Botox brow lifts are less expensive, ranging from $100 to $1,000 per treatment, based on how many injections of Botox are used. Brow lifts gained via Botox injections require upkeep costs, since the results are not permanent.

In general, brow lifts undertaken for cosmetic reasons likely will not be covered by personal medical health insurance, yet a plethora of plastic surgeons offer financing options for their patients.

Brow Lift Recovery

Recovering from brow lift surgery is also largely dependent upon the type of surgery experienced. A board-certified plastic surgeon who has extensive experience in guiding patients through the recovery periods from their brow lift surgeries will provide post-operative instructions to help individuals ease into their after-surgery care and heal properly.

The time it takes to recover from invasive brow lift surgery can be shorter or longer for some patients, but overall, patients can expect some of the following during their recovery period:

  • Elevation of the head for 48 hours and ice packs to reduce swelling
  • Pain medication and avoidance of strenuous activities
  • Healing of wounds in 10 to 14 days
  • Bandages to minimize bruising
  • Back to work or normal activity in 7 to 14 days
  • Botox brow lift patients should avoid reclining for four hours after treatment

Before & After Brow Lift Care

The method of preparing for brow lift surgery should be fully understood by the patient well before the procedure, in order to experience the best results. Whether undergoing an endoscopic lift or more invasive means of brow lift surgery, patients should be armed with the following knowledge.

Prior to Brow Lift Surgery

Weeks before getting brow lift surgery, a patient should be instructed by their plastic surgeon to perform tasks such as the following:

  • Give up smoking 30 days prior to getting brow lift surgery, because nicotine reduces blood flow, can slow the healing process, and cause problems with anesthesia - such as heart attacks and infections - according to the National Center for Biotechnology Information, U.S. National Library of Medicine and the American Society of Anesthesiologists
  • Don't take blood thinners such as aspirin, or any supplements, herbs and vitamins for 14 days before surgery in order to avoid unnecessary blood loss during the procedure
  • Cease drinking alcoholic beverages two days prior to surgery so that it won't interfere with anesthesia
  • If hair dye is desired, patients are advised to use it prior to surgery, since it won't be allowed for six weeks afterward
  • Abstain from eating and drinking for six hours or more prior to surgery
  • Buy all post-surgical needs before the surgery
  • Take off jewelry, makeup, and contact lenses before surgery

After Brow Lift Surgery

  • Consume Arnica and Vitamin C for 14 days to help lessen bruising and speed up healing
  • Get a friend or family member to drive you home and abstain from driving for 3 or 4 days post-surgery
  • Expect swelling, bruising, stitches or staples near or in the hairline
  • Take any prescribed antibiotics during the first 7 days after surgery to prevent infection
  • Stay away from NSAIDs such as Motrin, Advil or other ibuprofen to reduce bruising and swelling risks after Botox injections
  • Tell your doctor about any unexpected fevers, rashes, blemishes, cold sores, redness and swelling that doesn't dissipate
  • Keep all follow-up appointments
  • Refrain from manipulating the area of treatment and avoid facials until given the go-ahead by your medical professional

The Pros and Cons of Brow Lift Procedures

Patients who have received brow lift procedures have deemed the process worth it 88% of the time, according to the statistics collected by RealSelf. Although various types of brow lift surgeries can be accompanied by advantages and disadvantages, overall, individuals who discover their countenances improved at the hands of a skilled plastic surgeon love the manner in which a brow lift can take years off their appearances and make them look wider awake and happier.

Following are the pros and cons of different types of brow lift procedures:

The Pros and Cons of a Coronal Brow Lift: The benefits of a coronal brow lift include the fact that the long incision can be hidden in patients who have plenty of hair. It also offers the physician open access to the muscles of the forehead, and can provide a permanent way of lifting the brows and forehead without much scarring.

However, the disadvantages of the invasive coronal brow lift surgery means that it can raise the hairline for patients who don't want a higher hairline. The coronal brow lift also doesn't address brow asymmetry, and can cause hair loss at the incision site, a numb feeling, swelling, and possible headache pain.

The Pros and Cons of an Endoscopic Brow Lift: The less invasive endoscopic brow lift has the advantages of hidden incisions, a shorter surgery period, as well as offering the surgeon good access to muscles in the forehead.

However, an endoscopic brow lift can also raise the hairline, and potentially cause pain, swelling, hair loss, and a "pins and needles" feeling in the scalp.

The Pros and Cons of a Pretrichial Brow Lift: A permanent pretrichial brow lift has the benefits of not raising the hairline and offering scars that can be hidden well, along with giving the surgeon a good way to access the forehead muscles. However, the pretrichial brow lift can be harder to perform, and still comes with the risks of scars that can be seen, possible hair loss, pain, numbness and the "pins and needles" sensation.

The Pros and Cons of a Combination Mid-Brow Incision with Endoscope Brow Lift: When a mid-brow incision is used in combination with an endoscope, the surgeon gains direct access to the muscles of the forehead and scars might be well hidden. Conversely, the procedure can elevate the front hairline and potentially leave scars, cause hair loss, numbness and the "pins and needles" problem.

The Pros and Cons of a Traditional Mid-Brow Lift: A traditional mid-brow lift can work well for certain patients who benefit from the fact that the plastic surgeon can precisely determine where to elevate the eyebrows. It can also offer a way to trim any excess skin selectively.

However, the mid-brow lift still comes with the risk of scarring, and certain patients may discover that their brows could droop once more over a period of time. The mid-brow lift might also cause certain individuals to experience a changed sensation in their foreheads.

The Pros and Cons of a Direct Brow Lift: A direct brow lift offers exact brow elevation, and may have even fewer side effects than some of the above mentioned surgeries.

However, the direct brow lift surgery may cause droopy brows to return after a period of time. This type of surgery may also cause distortions with any deep furrows that already exist in the forehead. Other side effects include the possibility of an altered feeling in the forehead, as well as numbness and scarring.

The Pros and Cons of a Chemical Brow Lift: Botox brow lifts are known to have the advantages of being an easy and less expensive way to reduce the look of fine lines and gain a smoother forehead without undergoing the rigors of surgery.

However, the advantages of the non-invasive injections are joined by the fact that the Botox benefits are only temporary, requiring multiple treatments to continue experiencing the benefits as the Botox wears off. In the hands of an unskilled injector, or a patient who doesn't properly follow after-care instructions, Botox brow lifts may cause droopy eyelids or the overly arched "Spock Botox brow" appearance. Other side effects may include infection in the wake of the Botox injections, or pain, swelling, redness and bruising.

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