The use of the fiber-optic endoscope for performing brow and forehead lifting came of age while I was in my fellowship training and I was fortunate to be on the front end of that learning curve. Prior to 1993, most all brow lift and forehead lift were done using a large incision from ear to ear across the scalp that often resulted in numbness of the scalp, hair loss, and a wide, visible scar.
The endoscope not only obviated the need for that incision but ushered in a novel perspective for rejuvenating this area of the face. Rather than simply cutting and pulling the scalp, attention was directed on rejuvenating specifically those elements that were the result of aging. The technology improved as did our level of understanding about the aging process, and the “endoscopic browlift” evolved.
My Philosophy on Brow Lift and Forehead Lift
My current philosophy is to use the scope to allow me to alter a few specific muscles and attachments in order to render a subtle softening of appearance. Although the maneuvers I employ in each case here in Beverly Hills are different, I generally try to attain a similar aesthetic outcome. I prefer the center of the brows to be on the low side yet not too close together.
The brows should arch but there must not be too much distance between the brow and the orbital rim, as this can make the person look startled or hollowed out. I usually move the brows out to the sides rather than vertically. The muscles that enable a person to frown are sometimes divided or sometimes left alone. There is no skin removed with my technique.
The brows are secured to the bone in their desired position and any redundant tissues are redistributed backwards over the remaining scalp where there is a greater area to accommodate them. I feel that a well-executed brow lift is more conservative than a blepharoplasty as there is no tissue removed and no visible incisions.
Although one might be tempted to think of brow lifts and blepharoplasties as comparable operations with the same goal of improving the aesthetics around the eye they are not. Often times I find that performing both procedures allows for the optimal balance and aesthetics.
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FAQs about Brow Lift
A brow lift, also known as a forehead lift, is a facial plastic surgery that alters the signs of aging on the brow and forehead area. Common issues include the deep horizontal creases that appear on the brow, furrows between the eyebrows, and sagging skin that makes you look worn out.
During the initial consultation, the doctor takes a thorough medical history and performs a physical examination of your brow area. Your plastic surgeon will look at your bone structure, brow position, skin elasticity, and the thickness of your skin. This helps the surgeon create a plan for the surgery that you will discuss. If you’re in good health, you are an ideal candidate. Men and women who take blood thinners or who have medical conditions, such as heart disease, may be advised against the surgery. Every case is evaluated on an individual basis.
Patients often combine a brow lift with blepharoplasty. Talk to your doctor to see if you’re a good candidate for both procedures at the same time.
After the anesthesia is administered, several small incisions are made within the hairline. With the aid of a fiber optic endoscope, the doctor fixes the underlying muscle and tissue to help bring the brow back into an ideal position. Once in position, the brow is reattached to the bone and excess tissue is redistributed to other areas of the brow that could use filling. The muscles that control frowns may also be altered. The goal is to soften the signs of aging without raising the brow so much that the patient looks startled and without removing skin or tissue.
Every surgery is different, so it’s hard to give an exact time frame. In general, the surgery may take one to two hours to complete. In most cases, you will undergo the procedure and be released the same day.
One of the most important things you need to do is to stop smoking a few weeks before your surgery. Smoking inhibits healing. You will also need to refrain from smoking while you heal.
Listen carefully to your doctor’s list of medications that increase bleeding. These medications include aspirin, anti-inflammatory medications, and some vitamins and herbs. You must avoid these medications and supplements before and after the surgery. Closely following your surgeon’s pre- and post-operative instructions can help to ensure a good result while minimizing the risk of complications.
It’s important to get plenty of rest so that your body can heal. Sleep with your head elevated for a few days to lessen swelling. Ice packs also help with swelling. In a few days, you will return to have the bandages and drains removed. Expect some bruises and swelling. Swelling begins to subside after a couple days, and bruises fade after a week or two.
Your doctor will remove your stitches after a week. Make sure you avoid strenuous activities while you heal. Something as simple as bending and lifting a heavy item can pull at the stitches, so listen to your doctor about when to get back to your normal routine.
While the stitches are removed after a week, it’s normal to have swelling last for a few months. Scars fade within six months. Patients often find that they can return to work and other normal activities within one week.
Complications rarely occur during brow lifts. There is the chance of allergic reaction to anesthesia. If you’ve encountered issues during prior surgeries, let the doctor know. Hematomas may also occur if blood accumulates under the skin. Finally, there is the risk of infection at the incision site. Being honest with your doctor about your health, prescription and non-prescription medications, and following advice before and after the surgery is the best way to avoid any risk.
Brow lift surgery is typically considered cosmetic and elective and not covered by insurance.