Aesthetic Procedures: Brow and Forehead Lift

Understanding Brow Lift Procedures:

Brow and forehead lift (also known as browpexy) procedures are performed for multiple reasons. These include:

• Rejuvenating the brow area for a youthful appearance
• Smoothing forehead wrinkles and frown lines
• Elevating sagging brows to open up the eyes
• Creating the arched eyebrow or ‘fox-eye’ look
• Addressing overactive forehead and glabella muscles
• Shortening the elongated forehead
• Enhancing overall facial harmony

There are many ways in which a brow lift can be performed.

• Minimally invasive procedures

  • Less invasive procedures to help reverse brow ptosis include threadlifting and tightening using energy devices. A good example of the latter is radiofrequency energy, either through internal (FaceTite) or external (Morpheus 8) application. In addition, part of the ageing process affects the forehead and temporal fullness. This can be managed using fillers or fat grafting, which will help to produce the volume of youth.

• Traditional Brow Lift

  • A ‘ traditional’ or ‘hairline’ brow lift involves excisions at or in the hairline (coronal incision). This allows direct access to the muscle and fascia of the forehead and allows for safer, long lasting lifting by the anchoring of the deeper muscle and periosteal tissue directly to the bone. Anchoring can be done by devices such as Endotine, or direct suture to fascia and bone. It can also allow for the reduction of overactive forehead muscles, and forehead lowering or lengthening procedures. The drawback is the potential for visible scars and numbness of the scalp. These issues, if correct incision placement is done, are rare.

• Temporal brow lift

  • A temporal brow lift allows for the restoration of the eyebrow arch of youth. It is similar to a traditional brow lift but with shorter scars placed at or in the hairline of the lateral forehead. This allows for even less visible scars and quicker recovery. It is an excellent option for select patients where brow flattening is the main complaint.

• Endoscopic (Keyhole) Brow Lift:

  • The endoscopic browlift is a minimally invasive approach using tiny incisions in the scalp, and a telescopic camera (endoscope) to clearly visualize the structures of the forehead and brow and allow for precise dissection. The entire forehead and brow can be approached in this fashion. Through the small incisions, sutures or hook devices like the Endotine system can be used to lift the brow in the appropriate direction and anchor the deep fascia of the forehead to the bone to give a natural, refreshed appearance.

• Direct Brow Lift

  • A direct brow lift is the excision of skin at and above the eyebrows or at a crease in the forehead. This technique is usually reserved for older patients where scars can be hidden in the forehead creases.

Recovery and Aftercare

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 1^st 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.