Malposition of the eyebrows produces a heavy, tired look. Overactivity of the muscles between the eyebrows produces an angry look. When the browlift is done well, the final result is one of the most rewarding in aesthetic surgery; smooth, rested, rejuvenated. Done poorly, the patient looks startled. Clearly the answer is, Do It Well!
-Andrew Barnett, MD
Browlift, sometimes referred to as an upper face lift, is one of the plastic surgical procedures that can most enhance your appearance. The lines that go across your forehead, the deep creases that form between the brow, and the unattractive droop of the eyebrow itself can all be dramatically improved.
What do you mean by "browlift"?
The term "browlift", while commonly used, is actually misleading. While I sometimes do "lift" the brow, meaning moving it in a posterior direction to elevate the eyebrows, there are actually four separate problem areas that I approach: Eyebrow Droop, Vertical Wrinkles between your eyebrows, Horizontal Wrinkles across your forehead, and Hairline Position. You may have significant wrinkling with well positioned eyebrows. In this case, lifting your eyebrows would produce a startled, unattractive look. I see this common error when less experienced surgeons follow the "cookbook" approach to the browlift procedure.
What about eyebrow droop?
The three enemies of a youthful facial appearance are the sun, gravity, and facial tension. Sun actually changes the structure of the skin, causing it to lose elasticity. Gravity is a constant force, causing everything on our bodies to droop, and facial tension, the unfortunate byproduct of our stressful lives, puts deep wrinkles in our brow.
As we age, these three factors take their toll. With the loss of the natural stretch in our skin, the brow actually drops. At times, the outside portion of the brow droops more, producing a sad look. At other times, the central portion of our brows droop, giving us an angry look. This lowered position of the brow initially causes hooding, or an excess, of upper eyelid skin, giving many people the impression that they need to have an "eye job" when in fact the true culprit is the lowered position of the brow.
What do I need, an eyelift or a browlift?
The easiest way to tell is to look in a mirror. Look at the position of your brow, and look at the eyelid skin. Next, take your thumb and forefinger and place it above your eyebrow, gently lifting the brow into an attractive position (not too high!). If that eliminates most of the excess skin in the upper eyelid, a browlift may solve your problem. Many of my patients complain that with age, they find there's no place to put their make-up on the upper eyelid. That's due to brow droop.
Does a patient ever need both?
Quite frequently, yes.
What causes the wrinkling in the brow?
There are two separate areas of wrinkling. The Vertical Wrinkles, between the eyebrows, are called glabellar wrinkles. They are caused by the activity of little muscles located between the brow, called the corrugators. When we are angry, or have a lot of tension, we tend to contract these muscles. It is this frequent contraction that produces the vertical lines between the brows. The Horizontal Wrinkles, called frontalis wrinkles, are lines going across the forehead. As our eyebrows drop, we have a tendency to lift the brows using the muscle located in the central part of the forehead, called the frontalis muscle. Look in the mirror and see how you tend to lift your droopy brow, and how this produces horizontal wrinkles. It is the tension between the brows and fighting the droop in the front part of the forehead that cause the wrinkles.
What does a browlift do?
Through a hidden incision placed behind your hairline (we do not need to shave any hair!), I approach the problem areas. As needed, the brow is elevated and the active corrugator and frontalis muscles are snipped or reduced. Generally, no incisions or scars are visible on the forehead. The wrinkles on the brow are greatly reduced or eliminated completely, and the eyebrows sit in a rested, attractive position.
Is there more than one type of browlift?
Yes. The browlift procedure has changed dramatically in the past decade. There are now a number of alternative approaches, and your specific problem determines which procedure I recommend.
- The transpalpebral approach is performed entirely through incisions in the eyelids, generally when an eyelid lift is also planned. No incisions are placed in the scalp, and only limited elevation of the eyebrows is possible. This procedure however is excellent in approaching the vertical wrinkles between the eyebrows caused by the corrugator muscles.
- The temporal browlift is performed through two small incisions in the scalp. This procedure allows me to lift the eyebrows but is only suggested when a simultaneous eyelid lift is performed. The muscles between the eyebrows are approached through the eyelid incision, and the elevation of the brow is performed through the scalp incisions.
- The endoscopic browlift involves placement of two to five small incisions in the scalp. The muscles are reduced and the eyebrows are elevated with the assistance of an endoscope, which is a tool that allows the surgeon to visualize the internal structures of the forehead skin, viewing them on a television type monitor. The vertical wrinkles are reduced, and the eyebrows may be elevated.
- The bicoronal browlift is the traditional approach and uses a single longer incision across the top of the scalp. This approach provides the best visualization for correcting the horizontal wrinkles, for improving the very deepest vertical wrinkles between the eyebrows, and for repositioning the eyebrows.
Do browlifts elevate the hairline?
Sometimes. If the eyebrows need to be repositioned at a higher level, a very limited elevation of the anterior hairline will occur. If no repositioning is necessary, or only lateral eyebrow droop needs to be corrected, the hairline change is generally unnoticeable.
What if my hairline is already much too high?
In cases of very high or receded hairlines, an incision may be made at the the hairline, and the hairline can actually be lowered at the same time that the muscles and eyebrow droop are approached.
What about pain during and after the surgery?
There is essentially no pain during the procedure. As with all surgery, anesthetic is used during the operation. Some patients wish to be completely asleep, while others are more comfortable with "twilight" sedation. At your consultation, we will determine what is the best approach for you. After surgery, you'll feel swollen and tight for a week or two, but patients generally report there is very little pain. Medication for discomfort will be available, but most patients require very little.
How long does it take to recover?
While you'll be up and about the day following your procedure, most patients take five to seven days to return to work. This of course depends on your individual healing. It's important to know that full healing, as with any surgical procedure, actually takes a bit longer. During that time, your brow may be slightly oilier and have a numb sensation which improves in about three months.
What is the right age to have a browlift?
While some people never need a browlift, many women can benefit from a browlift as early as their late twenties. Men generally don't need a browlift until their late forties at the earliest.
How long does a browlift last?
Browlifts tend to be among the longest lasting facial cosmetic surgery procedures we perform. Nine out of ten people who have a browlift will never require another one.
Are there any risks to browlift?
As with any surgical procedure, there are risks. Bleeding, infection, and scarring may occur. Slight asymmetry between the brows may be present. Loss of function of the brow muscles, while extremely unusual, can occur. This information is given not to frighten you, but to help you make an informed decision. While browlift surgery has proven to be extremely safe, it should not be taken lightly.
Is a browlift right for me?
That's a question only you can answer. At your consultation, speak frankly, ask questions, and explain your expectations. We'll work together to help you make the decision that's right for you.