WHO IS A CANDIDATE?
MEN: In men, the ideal brow position is at the level of the supraorbital rim. Brow contour is typically more horizontal or oblique (rather than arched).
For men, brow lift candidates are generally those who have the brow positioned below the level of the supraorbital rim, or a downward slanting brow (sloping down from inner to outer brow). It is important not to over-lift the brow in men, as this takes away from a masculine look.
WOMEN: In women, the ideal brow position is above the supraorbital rim, with an arch where the middle third of the brow meets the outer third of the brow, and this arch positioned about a centimeter above the rim.
The ideal brow shape has changed over time, with a more upside down U shape being popular decades ago, with beautiful brows gradually evolving to the arched brow that is currently the ideal.
In women, brow lift candidates are women with the brow positioned close to or at the rim, when below the rim, or when downward sloping. In women it is important not to over-lift the brow, since then it gives a surprised (if inner brow is raised too high) or unnatural appearance.
WHY IS THE SURGEON RECOMMENDING A BROW LIFT WHEN I ONLY WENT IN FOR MY UPPER EYELIDS?
The most common presentation for someone who needs a brow lift is actually the patient who comes in thinking he or she needs an upper blepharoplasty (or upper eyelid tuck).
The drooping upper lids are often noticed first, when in fact the reason the upper lids look droopy is because the brow has fallen over time.
Why does this matter? Well, when the brow has fallen, the forehead subconsciously raises as soon as patients open their eyes, driven by the stimulus to want to maintain their vision and keep the eyelids out of the way.
(Hint-if you don’t notice you are doing this, look to see if you have horizontal forehead wrinkles. The more pronounced these are, the more you are raising your brow without realizing it. This test does not work in patients who have had Botox or Dysport, obviously.)
If the surgeon only fixes the upper lids in this scenario, and does not also fix the brow, after surgery the brow relaxes since it no longer has a stimulus to raise itself since the upper eyelid skin has been trimmed.
When the brow relaxes, the skin of the upper lids again looks droopy. In some cases, it is not that the brow needs to be lifted to a dramatic degree, but rather just slightly lifted and secured in that position.
DIFFERENT TYPES OF BROW LIFTS
There are various types of brow lifts, and they range from 2-5 small incisions (lateral or temporal brow lift, or endoscopic brow lift) to one large zig-zagged incision (coronal brow lift).
The coronal brow lift was the traditional brow lift that was done in the past. This has largely been replaced by the lateral or temporal brow lift, or the endoscopic brow lift, which both have smaller incisions and work just as well, if not better.
The manner in which the brow is secured in place after lifted can vary from suture fixation to tunnels in the bone, to an absorbable Endotine fixation method.
LOCATIONS OF INCISIONS
In the case of the coronal brow lift, the incision is zig-zagged (better for hiding the incision if the hair falls over it). In the temporal or lateral brow lift, often there is one horizontal incision about 1 cm into the hairline, above the lateral portion of each brow.
Additional more medial vertical incision may be utilized as well, and this may be done with or without an endoscope. The endoscopic brow lift typically has 5 short vertical incisions behind the hairline, one at the center, and 2 others on either side.
OTHER PROCEDURES THAT CAN BE DONE AT THE SAME TIME
Patients often combine the brow lift with upper eyelid surgery, upper and lower eyelid surgery, and/or a facelift/ necklift.
RISKS OF BROWLIFT SURGERY
The standard surgical risks include pain; bleeding; infection; scarring; painful or hypertrophic scarring; temporary or permanent hair loss along scars; visible scars; injury to vessels, nerves, surrounding structures; asymmetry; poor cosmetic result; prolonged edema, numbness, parasthesias; temporary or permanent nerve damage; need for further procedure and out of pocket costs; and risks of anesthesia.
Botox or Dysport may be helpful in the recovery period to prevent excessive forehead movement as the area heals.
WHAT TYPE OF ANESTHESIA IS REQUIRED FOR BROW LIFT SURGERY
Typically brow lift surgery is done under either general anesthesia, which is also useful when other procedures are being done at the same time.
Botox or Dysport may be helpful in the recovery period to prevent excessive forehead movement as the area heals. Walking the day of surgery is recommended.
You may wash the scalp 48 hours after surgery. Gentle shampoo (non-perfumed, non-irritating preferred) and water over the incisions is okay. Bacitracin ointment may be applied along the incision lines until staples are removed.
Elevating the head of your bed is helpful in preventing and alleviating swelling, and should be done for at least the first few nights following surgery.
Staples are removed 10-14 days after surgery. Dr. Patel recommends avoiding exercise for 6 weeks following surgery, at which time you can ease back into your workouts.
Light activity may be okay around 3 weeks after surgery. Bruising, if it occurs, typically lasts 7-10 days, and can be vary in intensity from patient to patient. You may return to work the week after surgery, depending on your pain level, stamina, and activities required in your occupation. You may drive once you are no longer taking pain medications, and allow a 24 hour minimum window between your last pain medication dose and driving.
All recovery processes and recommendations vary patient to patient, so these general guidelines may not apply to every patient. You will want to avoid photographs or events requiring photo or video for at least 2 weeks.
FOLLOWUP VISITS AFTER SURGERY
Dr. Patel typically sees patients the day after surgery for followup check, a week after surgery, 10-14 days after surgery to remove staples, at the 6 week mark, 3 month mark, and every 3 months thereafter for a year, and anytime during or thereafter as needed.