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Brow Lift

Brow lift surgery is surgery to reposition the eyebrow to a more youthful position relative to the eye. It counteracts the effect of gravity on the ageing eyebrow position. Brow lifts can also be used to correct asymmetrical brow positions or to help treat a drooping brow due to a nerve weakness. Repositioning the brow has an anti-ageing effect on the eye area giving a fresher, more rejuvenated appearance to the face. It counteracts the tired or heavy look around the eye area very effectively.

 Indications for Brow Lift Surgery:

  • Low lying eyebrow position or brow ptosis causing hooding of skin over the upper eyelid (Sometimes this is not immediately obvious due to compensation by the forehead muscles over-contracting to hold the eyebrow up.)
  • Asymmetrical eyebrow positions with one eyebrow lying lower than the other
  • Weakness of the nerve to the eyebrow muscles resulting in drooping of the eyebrow over time

Limitations of Brow Lift Surgery:

  • If there is extra skin on the upper eyelid as well as a low eyebrow position, then this will not be treated by a brow lift alone. An upper blepharoplasty or eyelid lift is needed as well in this situation to treat the excess tissue. The two procedures can be combined together very successfully.
  • Some types of brow lift will not affect the “frown lines” that form between the eyebrows. However, these can be very effectively treated with botulinum toxin (Botox®) injections.

Types of Brow Lifts:

There are several types of brow lifts available. Ms Nugent will recommend the most suitable procedure for you after her clinical assessment. Each can be carried out on its own or in combination with other procedures such as upper blepharoplasty, lower blepharoplasty and facelift surgery. Some are feasible to be carried out under local anaesthetic (while you are awake), while others are usually done under general anaesthetic (while you are asleep). Pre and post surgery clinical photographs of your face will be taken.

Brow Hitch

A brow hitch provides a subtle lift to the outer eyebrow. A small incision is discretely placed at the tail of the eyebrow and internal sutures are placed to lift or “hitch” the outer eyebrow up to a better position. This can be done under local anaesthetic as a day case procedure and takes about 30 to 40 minutes.

Lateral Temporal Brow Lift

A lateral temporal brow lift lifts and stabilises the outer two thirds of the eyebrow. It is done via incisions placed hidden in the hairline, in the scalp just above each temple. It may be performed under local or general anaesthetic as a day case procedure and takes about 60 minutes.

Endoscopic Brow Lift

An endoscopic brow lift elevates the eyebrow via 4 to 5 small incisions placed hidden in the hairline. The endoscope (keyhole instrument used to perform the surgery) is used to see from underneath the eyebrow attachments and they are released and repositioned from the inside. The eyebrow is usually stabilized in its new position by a temporary screw which is removed after about 10 days although sometimes this is done by internal means which do not have to be removed. The “frown” muscles can also be weakened by this technique. Endoscopic brow lifts are done under general anaesthesia as day case procedures and take 60 to 90 minutes.

Direct Brow Lift

A direct brow lift lifts the eyebrow by directly removing a carefully marked piece of skin above the eyebrow and securing the eyebrow to a higher position before suturing the skin closed again. The scar runs along the top of the eyebrow and usually heals very well. This is no longer the most popular technique used to lift eyebrows but in some circumstances is the procedure of choice. It is performed under local anaesthetic as a day case procedure and takes 30 to 40 minutes.

Transcoronal Brow Lift

A transcoronal brow lift is the most extensive type of brow lift surgery. It is done via an incision placed in the hairline that runs almost from ear to ear over the top of the scalp. It is not commonly performed nowadays but occasionally is indicated for a particular situation.

Post-Operative Course:

It is usual to have some swelling and bruising in the eyebrow and forehead area, which will settle over the 1 to 2 weeks following surgery. Particularly after an endoscopic brow lift, you may have a headache for 48 to 72 hours post surgery. Sometimes you will have numbness in the forehead or scalp area temporarily.

Sutures around the eyebrow will be removed at 1 week following surgery and those in the hairline will either be absorbable or be removed at 10 to 14 days post surgery.

Recovery:

Cool packs can be placed over the eye and forehead area for comfort and to help reduce swelling and bruising. It is best to avoid bending, stooping and any heavy or strenuous activity during the healing process. Sleep on 2 to 3 pillows at night to help reduce swelling. You can wash your hair from 48 hours post surgery. Avoid wearing contact lenses for 2 weeks. Most people can return to work after 1 to 2 weeks and get back to normal activities after 4 weeks. The scars usually heal very quickly and gradually fade to very well hidden fine lines.

Complications:

While most brow lifts go very smoothly and patients are delighted with the results, as with any procedure there are some risks associated with brow lift surgery.

  • Swelling and bruising. This will peak around day 2 to 3 post surgery and will gradually reduce after that. Most of the swelling is usually gone by 2 weeks but occasionally lasts longer than expected.
  • It is not unusual to have a headache for 48 to 72 hours following brow lift surgery, particularly endoscopic or transcoronal brow lift surgery. This normally resolves without requiring more than standard painkillers.
  • Occasionally there is more bleeding than expected from the incisions or bleeding under the skin forming a haematoma. Rarely a return to theatre or the procedure room is needed to deal with this.
  • Infection rates are low in brow lift surgery. If an infection occurs, you will be treated with antibiotics and rarely a return to theatre or the procedure room is needed to washout or further treat the wound.
  • Occasionally numbness in the forehead or scalp persists for longer than expected and very rarely a permanent small area of numbness occurs.
  • Slow healing/poor scars. Brow lift incisions usually heal very quickly and well but occasionally take longer than expected particularly if infection or bleeding has occurred. Occasionally the scars heal in a poorer condition than expected.
  • No-one is perfectly symmetrical and we all have differences between the two sides of our faces. These differences persist after surgery but are usually small enough that they are not overly visible and do not require any treatment. Occasionally further treatment is required to address a significant asymmetry following brow lift surgery.
  • Hair loss around incisions. Occasionally there is a small area of hair loss around the incisions in the hairline. This is normally temporary and usually resolves over time.
  • Weakness of eyebrow movement. Rarely there is weakness of movement of the eyebrow due to damage to the nerve controlling muscles in the area. This is usually temporary and resolves over time but occasionally persists longer than expected.
  • Disappointment with the result. Sometimes after undergoing a brow lift procedure, patients are disappointed with the result. This may be due to one of the problems described above occurring or due to unrealistic expectations of the surgery e.g. mild asymmetries or not realising an upper blepharoplasty procedure would be needed as well to gain the best result. It is important that you discuss your expectations in advance of the surgery so that you can understand what to expect from the surgery and so this situation is avoided as much as possible.  (Additional costs may be incurred for further procedures.)

Longevity of Procedure:

Brow lift surgery has a high success rate and is an excellent procedure for rejuvenating the eyebrow and eye area. You will continue to age at the same rate and in the same way that you always would have. However after brow lift surgery, the earlier effects of ageing are removed and your start point for future ageing is from a more youthful position. As the years go by, you may gradually develop further lowering of the eyebrows but this will be to a lesser extent than if you did not undergo brow lift surgery.

Before And After Blepharoplasty And Brow Lift Images

“Ms Nugent is not only a wonderful surgeon. She is a lovely person, easy to talk to and reassuring at all times” SB, facelift, necklift and brow lift at the Montefiore Hospital 2016

http://www.noranugent.co.uk/eyelid-surgery-blepharoplasty/