Brow (Forehead) Lift
A forehead lift or "brow lift" is a procedure that restores a more youthful, refreshed look to the area above and around the eyes. The procedure corrects drooping eyebrows and improves the horizontal lines and furrows that can make a person appear angry, sad or worried. It can also correct excess, hanging upper eyelid skin that makes one look tired.
In a brow lift, the skin and muscles of the forehead are raised to correct their previous drooping state. By doing so, the eyebrows are positioned and shaped to resemble their youthful years, while smoothing the forehead and minimizing frown lines. Dr. Stanwix typically performs a brow lift by using cutting edge minimally invasive endoscopic techniques. Dr. Stanwix therefore avoids the conventional surgical method, which utilizes an incision extending from ear to ear behind the hairline. The newer methods involve three to four small one inch incisions hidden well beneath the hairline. By using a small fiber optic camera to do the surgery the larger incisions are not necessary. This speeds your recovery and allows you to return to normal activities faster. Both techniques give excellent results with patients feeling more refreshed and rejuvenated a couple of weeks after surgery.
If you are considering a forehead lift, this page will provide a basic understanding of the procedure. Drs. Stanwix will provide more detailed information and answer all of your questions at the time of your initial consult.
Am I a Candidate for a Brow lift?
A forehead lift is most commonly performed in 35 to 70 years olds to reverse the visible effects of aging. However, it can also help people of any age who have developed furrows or frown lines due to stress or muscle activity. Individuals with inherited conditions, such as a low, heavy brow or furrowed lines above the nose can achieve a more alert and refreshed look with this procedure.
Brow lifting is often performed in conjunction with eyelid surgery (blepharoplasty) to provide an overall balance revitalized look to the entire area around the eyes. Patients who believe they need upper-eyelid surgery often find that a forehead lift better meets their surgical goals. Frequently patients also benefit from a full facelift with a brow lift to complete overall facial rejuvenation. It is always beneficial to think of the face as one unit and correct all aspects to provide maximal aesthetic benefits.
Patients who are bald, who have a receding hairline, or who have had previous upper-eyelid surgery are particularly good candidates for a brow lift. If necessary, Dr. Stanwix alters the location of the incisions if possible to hide them in inconspicuous places.
Remember, a brow lift can enhance your appearance and your self-confidence. It can give you a more refreshed look. Dr. Stanwix strives to provide his patients will natural brow lift results. Instead of a looking “surprised,” you will look as if you had a great night’s sleep.
Before you decide to have surgery, think carefully about your expectations and discuss them in detail with Dr. Stanwix.
Your Welcoming Visit
For a basic understanding of how a brow lift might change your appearance, look into a mirror and place the palms of your hands at the outer edges of your eyes, above your eyebrows. Gently draw the skin up to raise the brow and the forehead area. That is approximately what a forehead lift would do for you.
During your initial consultation, Dr. Stanwix will evaluate each detail of your upper face in order to plan the operation:
- The quality of your skin
- The position of your eyebrows
- The shape/configuration of the eyebrows
- The position of your hairline
- The amount of excess skin of your upper eyelids
- Asymmetry between your eyes and eye brows
- The bone structure of your forehead and eyes
- The muscle tone of your forehead
- The wrinkles across your forehead, frown lines, and crow’s feet
During your consultation, Dr. Stanwix discusses your goals for the surgery and ask you about certain medical conditions that could cause problems during or after the procedure, such as uncontrolled high blood pressure, blood-clotting problems, or the tendency to develop large scars. Be sure to tell Dr. Stanwix if you have had previous facial surgery, if you smoke, or if you take any drugs or medications -- including aspirin or other drugs that affect clotting.
If you decide to proceed with a brow lift, Dr. Stanwix will explain the surgical technique. They recommend deep sedation with local anesthesia or full general anesthesia for the procedure.
Getting Ready for Surgery
Dr. Stanwix will give you specific instructions to prepare for the procedure, including guidelines on eating and drinking, smoking, and taking and avoiding certain vitamins and medications. Carefully following these instructions will help with surgery and your recovery periods proceed smoothly. You will also be provided with a detailed patient instruction sheet for before and after surgery.
The Location of Your Surgery
Dr. Stanwix performs brow lifts at St. Francis Hospital’s Ambulatory Surgical Center. Brow lifting is done on an outpatient basis; rarely does it require an inpatient stay.
Dr. Stanwix will help you decide which surgical approach will best achieve your cosmetic goals: the classic or "open" method, the endoscopic forehead lift, or the minimal open approach. Make sure you understand the technique that recommend and why he feels it is best for you.
The traditional forehead lift
This technique is rarely used as the newer endoscopic technique is best for most patients. Importantly, if it is needed, oftentimes it is more of a minimal access approach.
Before the operation begins, your hair will be tied with rubber bands on either side of the incision line negating the need to shave your head.
For most patients, a coronal incision will be used. It follows a headphone-like pattern, starting at about ear level and running across the top of the forehead and down the other side of the head. The incision is usually made well behind the hairline so that the scar will be well hidden. Dr. Stanwix use a “trichophytic” closure, meaning that the hairs will grow right back through the incision to fully conceal the incisions!
If your hairline is high or receding, the incision may be placed just at the hairline, to avoid adding even more height to the forehead.
By wearing your hair down on your forehead, most such scars become relatively inconspicuous. Special planning is sometimes necessary for concealing the scar in male patients, whose hairstyles often do not lend themselves as well to incision coverage. If you are bald, Dr. Stanwix may recommend an endoscopic approach.
Working through the incision, the skin of the forehead is carefully lifted so that the underlying tissue can be removed and the muscles of the forehead can be altered or released. The eyebrows may also be elevated and excess skin at the incision point will be trimmed away to help create a smoother, more youthful appearance.
An alternative to the larger coronal incision is to make smaller incisions at the hairline. This is typically reserved for patients who do not have much of a drooping of the eyebrow, but who have a poor shape of it. The youthful eyebrow is meant to peak just outside half of its length. By making a small incision in the hairline, the eyebrow can be pulled more on this end to make it peak and give that appropriate aesthetic appearance.
The incision is then closed with sutures or staples. Your face and hair will be washed to prevent irritation and the rubber bands will be removed from your hair.
The Endoscopic Brow Lift
Typically, an endoscopic forehead lift requires the same preparation steps as the traditional procedure: the hair is tied back and secured with rubber bands.
However, rather than making one long coronal incision, Dr. Stanwix will make three to four short scalp incisions, each less than an inch in length. The endoscope, which is a pencil-like camera device connected to a television monitor, is inserted through one of the incisions, allowing Dr. Stanwix to have a clear view of the muscles and tissues beneath the skin. Using another instrument inserted through a different incision, the forehead skin is lifted and the muscles and underlying tissues are removed or altered to produce a smoother appearance. The eyebrows will also be lifted and secured into their higher position by placing very fine resorbable adherent plugs beneath the skin's surface.
When the lift is complete, the scalp incisions will be closed with staples and the area will be washed.
Complications are rare and usually minor with brow lifting. Yet, the possibility of complications must be considered.
In rare cases, the nerves that control eyebrow movement may be injured on one or both sides, resulting in a loss of ability to raise the eyebrows or wrinkle the forehead. Additional surgery may be required to correct the problem.
Formation of a broad scar is also a rare complication. This may be treated surgically by removing the wide scar tissue so a new, thinner scar may result. Also, in some patients, hair loss may occur along the scar edges. The most common complication is asymmetry of the brows as every individual has asymmetries to start with. Dr. Stanwix correctly matches the other side well during surgery, however, every individual heals different and uses various facial expressions which may cause some asymmetry with healing.
Loss of sensation along or just beyond the incision line is common, especially with the classic forehead lift procedure. It is usually temporary, but may be permanent in some patients.
Infection and bleeding are very rare, but are possibilities.
If a complication should occur during an endoscopic brow lift, Dr. Stanwix may have to safely stop the endoscopic approach and switch to the conventional, open procedure, which will result in a longer scar and a recovery period. To date, such complications are rare: estimated at less than 1 percent of all endoscopy procedures.
You can reduce your risk of complications by closely following the instructions of the Dr. Stanwix both before and after surgery.
Classic forehead lift patients may experience some numbness and temporary discomfort around the incision, which can be controlled with prescription medication. Patients who are prone to headaches may be treated with an additional longer-acting local anesthesia during surgery as a preventive measure.
You will be told to keep your head elevated for three days following surgery to keep the swelling down. Swelling may also affect the cheeks and eyes-- however, this should begin to disappear in a week or so. You should place ice over the forehead every 1 hour for 48 hours.
As the nerves heal, numbness on the top of your scalp may be replaced by itching. These sensations may take as long as six months to fully disappear. Dr. Stanwix will remove the stitches 10-14 days after surgery.
Some of your hair around the incision may fall out and may temporarily be a bit thinner. Normal growth will usually resume within a few weeks or months. Permanent hair loss is rare and the incision is well concealed because of the “trichophytic” closure.
Endoscopic forehead lift patients may experience some numbness, incision discomfort and mild swelling.
Incision site pain is usually minimal, but can be controlled with medication, if necessary. Endoscopic forehead lift patients usually experience less of the itching sensation felt by patients who have had the classic forehead lift. Keeping the head elevated for the first three days is very important as is applying ice. These two maneuvers will keep the swelling much lower and help decrease pain.
The staples used to close the incisions are usually removed in 14 days.
Feeling Normal Again
Although you should be up and about in a day or two, plan on taking it easy for at the first week after surgery. You should plan on showering and shampooing your hair within the day after surgery.
Most patients are back to work in a week. Endoscopic patients may feel ready to return even sooner. Vigorous physical activity should limited for several weeks, including jogging, bending, heavy housework, sex, or any activity that increases your blood pressure. Prolonged exposure to heat or sun should be limited for several months.
Most of the visible signs of surgery should fade completely within about two to three weeks. Minor swelling and bruising can be present but it usually not noticeable. You may feel a bit tired, but your energy level will increase as you begin to look and feel better.
Your New Appearance
Patients are overwhelmingly pleased with the results of a forehead lift. Often, patients don't realize how much their sagging forehead contributed to the signs of aging until they see how much younger and more rested they appear after the lift. Dr. Stanwix takes before and after pictures to show you your new look.