Brow Lift

Also known as a forehead lift, a brow lift is a surgical procedure performed to reduce signs of aging in the forehead area. It aims to remove or minimize deep horizontal creases across the forehead and bridge of the nose, and the frown lines between the eyebrows. It also lifts the eyebrows, making the eyes look more open.

Common Brow-Lift Techniques

There are two techniques used for performing brow lifts. The classic lift requires a long incision that runs across the top of the head, at the hair line, and down to the ears. However, for a woman who has a high forehead, a coronal incision, which is made behind the hairline, may be used. The endoscopic lift requires three to five small incisions that are made across the forehead, at the hairline. These shorter incisions mean a shorter recovery time and less scarring than those from a traditional brow lift.

Which technique is chosen depends on the thickness, texture and elasticity of the skin, the bone structure of the face, the overall appearance of eyebrows and eyelids, and the position of the eyebrows.

The Brow-Lift Procedure

Brow-lift surgery usually takes about one to two hours to perform, and takes place at a hospital, an office-based surgical suite, or an ambulatory center. Either general anesthesia or intravenous sedation is used. Depending on the surgical technique used, one long incision or a series of small incisions is made. Tissue and muscle underneath the skin are moved or repositioned as necessary. At the end of the procedure, the incision(s) is closed with sutures, screws, adhesives or surgical tape; a drain may be put in to collect excess blood and fluid. Postsurgery, the patient is moved to a recovery area for observation.

Recovery from a Brow Lift

A patient typically returns home on the day of the brow-lift surgery, although an overnight stay may be necessary for some. Swelling may be pronounced for the first day or two after surgery, although most swelling goes away within 2 weeks. To prevent post-operative bleeding, bending and heavy lifting should be avoided for a few days. It can take up to 6 months for swelling to fully subside and scars to fade.

Results of a Brow Lift

Depending on the patient's presurgical appearance and goals, a brow lift's results, which can be seen immediately, can be either subtle or dramatic. Eyes will appear more "open," and creases across the forehead, bridge of the nose, and between the eyes will be much less prominent.

Risks Associated with a Brow Lift

Prior to scheduling surgery, the patient and surgeon should fully discuss the risks associated with a brow lift. In addition to those associated with any type of surgery, a brow lift's risks include the following:

• Hair loss around the incision site(s)
• Facial asymmetry
• Higher hairline
• Injury to facial nerves
• Eye dryness/irritation

The chance of complications is minimized by choosing a board-certified plastic surgeon who has experience in performing brow lifts.

Additional Resources

• MedlinePlus
• National Institutes of Health
• Centers for Disease Control and Prevention
• Eunice Kennedy Shriver National Institute of Child Health and Human Development
• U.S. Department of Health & Human Services
• WebMD

It is important for a patient to have realistic expectations before undergoing cosmetic blepharoplasty. Although the procedure can enhance appearance and improve self-confidence, it does not radically alter the face.

Candidates for Blepharoplasty

The best candidates for blepharoplasty are those who are in good overall health, do not smoke, do not have any serious eye conditions, and have healthy facial tissue and muscle.

People with eye disease, including glaucoma or retinal detachment, thyroid disorders, diabetes, cardiovascular disease or high blood pressure are not good candidates for blepharoplasty.

The Blepharoplasty Procedure

Blepharoplasty is typically performed as an outpatient procedure requiring local anesthesia and sedation. General anesthesia may be used for anxious patients. Patients can choose to have this procedure on their upper or lower eyelids, or both. The procedure can take anywhere from 45 minutes to 2 hours, depending on whether both the upper and lower eyelids are operated on.

If the upper eyelid is being operated on, an incision is typically made along its natural crease. Once the incision is made, fat deposits are repositioned or removed, muscles and tissue are tightened, and excess skin is removed. For the lower eyelid, an incision is usually made just below the lash line so that excess skin can be removed.

After the procedure, the incisions are closed with sutures, tissue glue or surgical tape, and usually loosely covered with gauze so the area can heal.

Recovery After Blepharoplasty

After blepharoplasty, patients may be advised to apply lubricating drops/ointment and cold compresses to aid in healing and minimize side effects. Most patients return to work within a few days to a week, but should avoid exercise and strenuous activities for at least 2 weeks. Stitches are usually removed after 3 or 4 days. Most swelling and other side effects typically subside within 2 weeks. Contact lenses and eye makeup may not be worn for 2 weeks after surgery. Patients are typically advised to wear dark sunglasses outside or in bright light for 2 weeks to protect their eyes from sun and wind.

Risks of Blepharoplasty

Although there may be swelling and bruising around the surgical site, they will subside on their own, and the eyelids will improve in appearance for up to a year. Uncommon side effects include infection, reaction to anesthesia, and double or blurred vision. Eyes may be irritated and dry due to a temporary change in tear distribution. Side effects such as uneven healing and permanent scarring are rare but, if they occur, may require surgical correction. The scars from blepharoplasty are well-concealed, and usually fade with time until they are virtually undetectable. Although the eyelids are still subject to aging, blepharoplasty produces long-lasting results.

Additional Resources

• MedlinePlus
• National Institutes of Health
• Centers for Disease Control and Prevention
• Eunice Kennedy Shriver National Institute of Child Health and Human Development
• U.S. Department of Health & Human Services
• WebMD