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Some plastic surgeons provide expertise in creating the youthful, more awake appearance that brow lift surgery offers. The contour and position of the skin, fat, muscles, and brow around the eyes is largely responsible for facial expression. Wrinkles and lines often first appear in the brow and forehead area along low positioned eyebrows and heavy lids, which all become more prominent as time goes on. Sun exposure, genetic influences, weight fluctuations, and smoking can be contributing factors that together produce a tired, older, and even sometimes a scowling appearance.

A Brow lift (also called a forehead lift) can smooth out the lines and wrinkles and correct drooping brows and heavy eyelids to provide a younger, friendlier and more rested appearance.

Frequently, patients will present for surgical correction of upper eyelids when in fact it is the sagging or drooping of the brow that causes an overly tired appearance and "hooding," or heaviness, of the eyelids. In some cases, upper eyelid surgery alone can make this appearance worse.

Brow lift patients often receive this surgery along with upper eyelid surgery and face lift surgery for a more complete correction.

Brow lift surgery may be performed by either the "classical," or open approach, or by the endoscopic "minimal" scar method depending on each individual's personal requirements. Each brow lift patient has individual requirements, and a complete consultation and examination is needed to determine which surgical procedure, or combination of procedures, is required to obtain the desired results.

The "classical" or open brow lift approach is performed through an incision over the top of the head extending from one temple area to the other and well behind the hairline in order to hide the scar. This type of brow lift incision generally connects with the "standard" type facelift incision on each side of the temporal scalp above each ear. This procedure will raise the eyebrows, minimize the presence of lines and wrinkles, and reduce the folds and/or heaviness above and around the upper eyelids.

With a classical brow lift, the forehead will become somewhat higher, and the hairline will move up to some degree. In certain cases, where it is not desirable to raise the hairline any further (i.e. in an already high forehead/hairline), the incision can be made along the anterior hairline. This incision can be made in such a way as to allow hair to grow directly through the scar for further concealing. In selected cases, a lateral brow lift may be performed which elevates only the outside portion of the eyebrow. The lateral brow lift places the incisions predominantly in the temporal scalp areas and not across the top of the head.

Many plastic and cosmetic surgeons perform the latest endoscopic or "minimal" scar brow lift, which is performed through four one-half inch incisions placed just behind the hairline. With the aid of a fiber optic camera and specialized instruments, mini-scar brow lift is performed while viewed on a TV monitor. Generally, small incisions are placed just behind the temporal hairline and frontal hairline in-line with each eye. Through these small incisions, the procedure is completed much as described for the open brow lift procedure. However, there is no continuous scar and scalp excision across the top of the head.

An endoscopic brow lift will generally improve horizontal forehead lines, but not as noticeably as an open approach. Advantages of Endoscopic brow lift are smaller incisions and scars, and less potential for hair loss and numbness. Modified placement of incisions can be made for balding patients who require a brow lift procedure.

Regardless of which technique is used, a proper brow lift should produce a natural appearing result and not a "surprised" look or unnatural hairline.

Brow lifts can be performed using local anesthesia with intravenous sedation or general anesthesia. Procedure time for a brow lift ranges from one to two hours with an additional one to two hours if eyelid surgery is performed.

Generally, a padded cotton head dressing is applied for one to two days. Varying degrees of swelling and bruising will occur around the forehead and eyelids, and may extend down to the cheek area. It generally takes one to two weeks for most of the bruising and swelling to resolve. Itching, tingling, and numbness will diminish over time as the incisions heal. Sutures (stitches) are removed between one and two weeks (five to seven days for eyelids). Cold compresses and head elevation will reduce bruising and swelling. Patients do not generally complain of pain after brow lift surgery. Any discomfort is easily controlled with medication. Strenuous activity should be avoided for six to eight weeks.

Brow Lift Complications

As with most cosmetic surgical procedures, complications are infrequent when performed by a skilled and competent surgeon. Complications include, but are not limited to, anesthesia risks, bleeding, infection, difficulty with eyelid function or closing the eyelids, weakness or paralysis of the forehead/brow muscles with asymmetry, numbness in the forehead and/or scalp, poor or delayed healing, widened scars, and hair loss. Complications may require additional or revisional procedures. Potential for complications can be higher in those with certain medical conditions.