The brow and forehead are very underestimated parts of the facial aesthetics. Whilst most people focus on the eyelids, cheeks and jawline in their quest to reverse ageing features, the brow and forehead play an important role in the overall harmonious aesthetic of the face.
The brow and forehead make up the upper third of the face, from the hairline to the eyebrow line. While individual preferences vary, the ideal brow in women should be situated above the bony rim of the eye, with a slight peak at the junctions of the middle and lateral third of the eyebrow, whilst in men, the eyebrow is usually more horizontal. The glabella region situated between the brows as well as the forehead should be smooth in repose yet move naturally with facial expression, whilst the temple region should not be hollow, and the hairline not receded. An additional consideration is the relationship of the eyebrow to the upper eyelid, which needs to be addressed in continuity (see upper eyelid blepharoplasty).
Brow and forehead lift (also known as browpexy) procedures are performed for multiple reasons. These include:
There are many ways in which a brow lift can be performed.
Often, the first sign of brow ptosis is looking tired. The arch of the eyebrow is lost, and the outside of the eyebrow appears lower than the inside. As brow ptosis progresses, it may actually lead to blockage of the upper eyelids laterally, leading to blockage of the visual fields. In these instances, browpexy needs to be performed for improvement of function.
As the brow descends, the muscles of the forehead paradoxically contract to try and help lift the brow from the upper eyelids. This leads to the formation of forehead lines and wrinkles. Initially, they are more prominent at rest, but as time progresses, they can become permanently etched even at rest. Another sign of brow ageing is an elongation of the forehead, which changes the horizontal ratio of the face.
Through personalized consultations with our experienced surgeons, your concerns, expectations and desired outcomes will be discussed. An appropriate treatment plan and approach will be suggested. Sometimes, options may be given based on your ability to tolerate downtime, as well as based on the extent of your brow droopiness. As part of the consult, your overall health and suitability for the procedure will also be evaluated.
Before the actual procedure, you will be given preoperative instructions on how to get yourself ready. The procedure may be performed under local anaesthesia, sedation or general anaesthesia, depending on the extent of the brow lift, the technique used and your ability to tolerate pain. Whatever the method used, measures are in place to ensure a safe and comfortable experience.
Depending on the type of brow lift, incisions are usually in or at the hairline. Very rarely does any hair need to be cut for the procedure. After appropriate dissection to free the attachments to the forehead and brow, various fixation methods are used to lift and shape the brow, anchoring the brow to the bone or periosteum. Excess skin may then be excised, and the surgical incisions closed carefully to reduce any scarring risk.
Right after the operation, a pressure dressing is usually applied to the forehead to reduce swelling and bruising and prevent blood clot formation. This dressing is usually removed within the 1st to second post-operative days. Drains are rarely needed. Sutures, if any, are removed at 1 week post-operatively with minimal discomfort. Whilst healing, you can still wash your head and face, with extra care to clean any suture lines and apply antiseptic. The swelling and bruising are usually maximal in the first week, after which it drops off dramatically. Manoeuvres such as cold compress to the forehead and taking arnica can help with reducing this. At 2 weeks post-procedure, about 80-90% of the swelling is gone, and you can return to almost full normal activities.
Risks of the procedure include bleeding, pain, infection, and visible scarring. Though rare, these are all manageable with various interventions in the post-operative recovery period.
It is important in your consult with your plastic surgeon to express your desires and expectations such that a treatment plan can be formulated based upon realistic goals and outcomes. Open communication with your surgeon is key to this step, including a thorough examination to determine your suitability. Depending on which procedure you choose, each has its limitations and benefits. Generally, the less invasive a procedure, the less significant lift can be expected. However, with more advanced technology and procedures, there is an increasing shift towards procedures with less scarring and downtime.
At Polaris Plastic & Reconstructive Surgery, our surgeons are well-trained to perform a comprehensive assessment of your facial anatomy and find the procedures which suit your needs. To help in the consultative process, advanced 3D digital imaging software may be used to simulate the surgical procedure, even coming up with various virtual outcomes to make your choice easier. Most importantly, we are committed to tailoring the surgical plan to meet your unique needs in a warm, safe environment where any concerns or questions you may have can be addressed appropriately.
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