The forehead is often one of the first areas to show telltale signs of aging. Time, gravity, genetics and chronic sun exposure act synchronously to produce these changes. Loss of tone leads to forehead sagging and low eyebrow position. Muscle action over many years leads to horizontal creases across the forehead and frown lines between the eyebrows. A drooping brow can give a tired or sad appearance and some individuals unconsciously contract the muscles of the forehead continuously to help lift their brow that in turn creates even deeper forehead lines.
A brow lift (forehead lift) is a surgical procedure that re-contours the skin of the forehead, lifts the eyebrows to a more youthful position and refreshes the upper eye region. A brow lift will reverse the effects of gravity and aging and reposition the soft tissues of the brow. It is often combined with a facelift or blepharoplasty. A brow lift should give you a look refreshed, natural and rested appearance with natural animation.
Who is a Good Candidate?
Good candidates for a brow lift include women or men who are healthy, in good physical shape, and at their ideal body weight. Candidates for brow lift surgery should be emotionally stable, have the support of their surrounding friends and/or family members, and be fully educated about the procedure.
Who is not a Good Candidate?
Smokers, patients with multiple or untreated medical problems, and individuals who are psychologically unprepared for surgery are not good candidates for a brow lift. Those who have been encouraged by others to change their appearance or with unrealistic expectations should not have this surgery.
What to Expect at Consultation
At your initial consultation I will take a full medical history including all details of current and past illnesses, medications (prescribed or otherwise), lifestyle and past history of any previous surgery. We will discuss what it is that you do not like about your features and what you are hoping to improve. It is important to be open and honest at this stage with regard to what troubles you and what your expectations are so that we have a shared vision of what you are hoping to achieve.
I will assess you clinically and take a number of measurements. It can be quite disconcerting to have someone stare at you face for a period of time and analyse it but this is an important part of assessment so please bear with me! Different brow lift operations can be individualised to your particular anatomy, needs and aspirations. The particular surgical technique recommended will depend on your skin quality, the degree of skin elasticity and redundancy, the position of your eyebrows, amount of excess upper eyelid skin, and the shape and height of your hairline. We will discuss what is and what is not possible for your individual anatomy and the potential outcomes, risks and complications of the surgery. I will also advise if any additional procedures are likely to enhance the results. I always see you a second time before proceeding to surgery to answer any questions that you may have.
Preparing for Brow Lift
You should be physically fit and at a healthy weight which should be stable prior to embarking on facial plastic surgery. Your health will be assessed pre-operatively and you may need some tests that will be arranged if required. You should stop smoking at least 6 weeks ahead of surgery to reduce the risk of wound healing problems. You should stop aspirin, anti-inflammatory medications and any non-prescribed medication at least a week before surgery. If there is any change in your health prior to your surgery date you should let me know. Your health and general well being are my primary concern when I am treating you therefore if you are unwell for any reason it may be necessary to postpone surgery.
What to Expect on the Day of Surgery
A brow lift is done under general anaesthetic for optimal comfort, control and safety. The incisions are made based on your anatomy and type of brow lift. The skin of the forehead is elevated and the deep layers of the forehead are lifted. The muscles may be re-positioned or weakened depending on your individual needs. The eyebrow position is corrected and the skin re-draped. The skin and deeper layers of the brow are then fixed in their new position to underlying soft tissue or bone. The excess skin is trimmed and the wounds are closed.
When you wake up there will be soft dressings to make you comfortable. Brow lift surgery is not normally very painful but you may feel some discomfort and tightness, which is normal. You will return to the ward around an hour after the procedure and be able to eat, drink and get up out of bed. You will be numb around the brow but the feeling will gradually return over the coming months. It is unusual for the loss of sensation to be permanent. You would normally stay in hospital for the first night after the operation and go home the following day. You will need someone to pick you up from hospital and to give you some support for a couple of days at home. It takes several months for the final results to be evident and for all scars to settle.
What to Expect After Discharge
The face has a good blood supply so brow lift incisions tend to heal very well with good quality scars. The skin is usually mostly healed at your first post-op visit when any stitches are removed. You will be swollen and bruised at first and you may notice asymmetry or an uneven appearance of the skin in the first few weeks after surgery. This is normal and will usually settle down over the following weeks as healing progresses. At around two weeks post-op obvious signs of surgery such as puffiness or discoloration should start to dissipate and the improvements from the procedure will start to become more obvious. Sleeping with a few extra pillows to elevate the head can help speed the resolution of postop swelling. It may take several months for the final results to be evident and for all scars to settle to fine white line scars.
The scars are permanent but are normally well concealed in the hairline or natural contours of the face. Until the scars have settled it is important to minimise direct sun exposure. If you maintain this as a life-long behaviour beyond the scar maturation process it will help to maintain your rejuvenated appearance and to minimise future sun related aging.
You will be able to wear makeup over sunblock at one week post-op. You should avoid hair colouring for at least a month after surgery.
You should plan to be off work for at least 2 weeks depending on the type of work you do. You can return to gentle exercise at 3-4 weeks but avoid anything vigorous for 6 weeks.
Risks and Potential Complications
When you are considering any type of surgery you should be fully educated about potential risks and complications. The majority of patients are delighted with their results. Common complaints are numbness, bruising and swelling. Infrequently patients may experience infection, a collection of blood called a haematoma, delayed healing, skin necrosis, seroma and abnormal scarring. Abnormal scars are those that become red, raised and prominent for longer than expected. You will be under regular review after surgery and if there are any concerns with how your scars are progressing we will commence scar therapy. The facial nerve controls the muscles of facial expression and in rare circumstances can be damaged. The resulting weakness can last a number of weeks but is rarely permanent. Having a general anesthestic carries risks of respiratory or cardiac compromise and venous thromboembolism (DVT and PE).