Brow Lift

Why people want to change their eyebrows?

The eye brows are important tool for facial expression. Ideally, a woman’s eyebrows should arch on or slightly above the upper orbital rims (upper rim of the bone over the eye) and a man’s should arch along the rims. If the eyebrows are displaced downwards, the face may portray certain stereotype expressions. For example, downward displacement of the inner portion of the eyebrows often depicts an expression of ill will; downward displacement of the middle portion of the eyebrows may depict an expression of sadness. And overall downward displacement of the eyebrows suggests fatigue. Similarly forehead wrinkles relay certain facial expressions. Deep vertical lines between the eyebrows (in the glabellas region) give the unintentional impression of anger, annoyance, or a scowl, whereas a heavily lined forehead may give a tired and worried expression.

What Causes drooping?

People with low set eyelids may have been born with them or they may be due to gravitational pull. More commonly, though, they are a manifestation of biological aging, which is determined by hereditary factors. Gravitational pull on the skin of the forehead may aggravates the problem.

What are options?

Brow lift surgery improves the face dramatically by creating a brighter, softer, fresher appearance. It lifts heavy eyebrows away from the eyes and smoothes out vertical lines between the eyebrows and transverse lines across the forehead.

Careful assessment by the surgeon is critical to ensure a satisfactory cosmetic result. Frequently, droopy eyebrows and excess eyelid skin are a combined problem. If this is the case, simply removing some eyelid skin will not correct the problem. In fact, it may worsen it by creating a shortage of skin in the upper lid causing the brow to be pulled down further.

If both a brow lift and blepharoplasty are found to be necessary, it is important to place the eyebrow in it correct position by performing the brow lift surgery first. In this way, less upper eyelid skin is removed during the blepharoplasty, thus preventing any problems with eyelid closure.

Brow lift surgery for forehead wrinkles is particularly effective in correcting droopy eyebrows as well. If, however, droopy eyebrows are not the problem, other options may be considered, including laser resurfacing, collagen implants or muscle relaxants such as Botox.

Asymmetrical eyebrows, where one side its higher than the other, may be improved by lifting the brow on the droopy side.

What is involved in a brow lift?

Two surgical techniques are used; each having distinct advantages and disadvantages:

• The coronal technique is an incision made either in the scalp or at the junction of the scalp hair and forehead.
• Endoscopic Technique

The coronal technique is the most popular because the incision is hidden by the hair. By partially removing some of the muscle as well as the redundant skin, furrows and wrinkles on the forehead can be smoothed out at the same time the brows are lifted.

The surgery is now being performed through keyhole using an endoscope. With conventional scalpel surgery the incision is made from ear to ear across the top of the forehead just within the hairline. The incision is much smaller with the endoscopic technique. The endoscope allows the surgeon to work under the skin without having to pull the entire skin flap away from the forehead.

FAQs

Will there be a scar?

The incision with the conventional coronal technique heals with a cosmetically acceptable, fine white scar which is normally camouflaged within the hair. The scar however will be more obvious in balding men and women with diffuse hair loss. At first the scar may feel bumpy and irregular but becomes smooth and flat within 6 months.

The incisions with endoscopic technique are very small and therefore easier to camouflage. In women the incision is usually placed behind the hair line just above the ears. In this manner the scar is much less obvious in these individuals because hair loss normally takes place on top of the head.

How long does brow lift surgery take and does it hurt?

The length of the surgery varies with the technique being used and the extent of the correction. The actual surgery is painless because a local anesthetic is used to numb the area prior to the procedure. After the freezing wears off, some discomfort may be felt along the incision. A temporary headache and tightness of the forehead and scalp may also be experienced. Normal painkillers for initial three days should be sufficient for this.

When can normal activities be resumed?

With conventional surgery swelling and bruising will last approximately 7 to 10 days, whereas endoscopic method, the recovery period is only 3 to 4 days. Most people do not feel presentable in public until the initial stages of swelling and bruising have passed. Elevation of the head is recommended until the swelling has subsided.

How will surgery affect the face?

A conventional coronal brow lift will raise the hair line and a hair style change may be recommended if the change is quite dramatic. This is not as significant as a problem when endoscopic technique is used.

A softer, brighter, more alert and youthful look will be noticed after the procedure. The appearance of the upper eyelids also improved and the eyes will look wider.

How long the result last?

Brow lift surgery does not prevent aging. Lines of expression over the fore head and between the eyebrows will still be present, although to a much lesser extent. With time they become more pronounced but the youthful effect created by the surgery remains for a prolonged period of time.

Possible Complications of Brow Lift

• Prolonged redness of a scar: is unusual The scar may also be tender and lumpy. Eventually this subsides but it may take 1 to 2 years. The vascular lasers (pulsed dye or variable pulse width) can be used to remove the redness. Injections of cortisone and resurfacing with the carbondioxide laser can smooth out raised and uneven scar tissue. Medications and ointments are not effective in speeding up the healing process. Makeup can be used to camouflage a scar until it is healed.

• Balding: men, and less so women, with male – pattern hair loss or a strong family history of balding are cautioned about scarring. As balding progresses, a scalp scar will become more and more apparent because it is no longer hidden with in the hair. A scalp incision often accelerates hair loss because of the tension of the scar and the subsequent interruption of the blood supply to the scalp. Other causes of hair loss in the region of the scar are infection and hematomas, both of which are rare. This is much less of a problem with the laser and endoscopic technique.

• Loss of sensation: often, a transient loss of sensation over the forehead and scalp to the crown of the head is felt. Feeling returns to the forehead within 4 to 6 weeks and to the scalp after 6 to 9 months. The smaller incisions used with the endoscopic technique significantly reduce the occurrence of this complication.

• Overcorrection: if too much skin is removed, the face may look surprised or startled. With time gravity’s effect will improve this result. Overcorrection is often accompanied by too much tension at scalp incision. This may cause poor healing, a wide scar, and hair loss.

• Itching: this may be troublesome, especially in the scalp area behind the incision. Fortunately this eventually subsides as the incision heals.

• Muscle weakness: muscle weakness is usually a temporary condition which gradually disappears. A positive aspect of this is that the forehead furrows markedly diminish with relaxed muscles.