Cosmetic Surgery Patient Network
Lift - Forehead Lift
Lifting The Brows For Rejuvenation
I'll be having a temporal lift
or temporal lift and endoscopic lift combo soon. Although, Obagi NuDerm
really rid the wrinkles and crepiness from forehead, the outer brows are
starting to sag way too much for me to look at every morning! The drooping or lowering of
the eyebrows is frequently one of the earliest signs of aging. I have this
-- joy. This condition is
often overlooked because most people are unaware of the problem and the marked
improvement its correction can provide. Additionally, horizontal wrinkles
and vertical frown lines in the glabella (between the brows) can be
improved with this procedure.
Just be careful who
you choose to perform your procedure, you don't want to look like you're
surprised or like you have a thought all day. Natural and subtle wins the race here.
Unless, of course, you want to have very arched brows. I like a
medium to significant "slant" of the outer brow. Think Tyra
Banks. I like that look.
a Brow Lift?
The brow lift or forehead
lift is the procedure that raises the eyebrows usually with several
techniques to rejuvenate the eyebrows and rid one of a furrowed or angry look.
The usual techniques are as follows:
with 3-6 incisions (averaging at 4) behind the hairline; often used in
younger individuals who do not need much rejuvenation.
endoscopic technique with suture suspension: This
procedure is the same as the above technique but uses internal, permanent suture
material to suspend the muscles, either by sewing through the muscle or
muscle fascia or
suspending it from a surgical "barb".
a full coronal technique: where full long incision
is utilized from the temple on one side to the other. Permanent numbness
and hairloss is usually an issue for many people.
subcutaneous brow lift technique: this technique is
done in front of the hair line. Some surgeons report a more slanted
incision rather than a direct surface to fascia or other incision. There
are reports that this results in a lessened scar but there is little
widespread, proven information at this time. This technique leaves
a visible scar.
temporal brow lift: Also known as a lateral brow
lift, where two incisions are made above the temple to lift the brows and
forehead, laterally. This procedure can create an exotic outer
arched brow look that can be very subtle and desirable. This
procedure is not performed by all surgeons.
The muscles addressed in brow lifts (superficial cutaneous-only
lifts excluded) are the:
frontalis: the muscle of the forehead that
forms part of the occipitofrontalis -- called also frontalis muscle
procerus: a facial muscle that arises from
the nasal bone and a cartilage in the side of the nose and that
inserts into the skin of the forehead between the eyebrows
There is an additional procedure that can prohibit the corrugator
muscle from "furrowing" your brow -- sometimes called corrugator
excision, corrugator 'clipping' or myectomy (the removal of muscle).
Although it doesn't always prove as being permanent in some patients.
You a Candidate
for a Brow
and foremost, an individual must be in good health, not have any active diseases
or pre-existing medical conditions and must have realistic expectations of the
outcome of their surgery. Communication is crucial in reaching one's
goals. You must be able to voice your desires to your surgeon if he/she is to
understand what your desired results are. Discuss you goals with your
surgeon so that you may reach an understanding with what can realistically be
You must be mentally
and emotionally stable to undergo an cosmetic procedure. Cosmetic surgery is not
getting a cavity filled. This is an operation which requires patience and
stability in dealing with the healing period. There is sometimes a lull or
depression after surgery and if there is already a pre-existing emotional
problem, this low period can develop into a more serious issue. Please consider
this before committing to a procedure. It the above
describes you and you have the desire to rid
angry-looking brows or superficial wrinkles on the forehead -- you may be a good
candidate for a brow lift. Although, if there is excessive sagging skin all over
the face and below the brow, other rejuvenative procedures such as a
Lift, Platysmaplasty (neck lift) or Blepharoplasty
may be beneficial.
to Expect at Your Consultation
checking a few surgeons' backgrounds and credentials, you will make an
appointment for a consultation. You will meet with these surgeons and discuss
your goals and you will disclose all information regarding your health; if you
smoke, what medications or vitamins you presently take, etc. -- this is very
important. Visit the Medication & Supplements List
for more information.
You will discuss
your complaints and concerns and discuss the various looks one can achieve, the
amount that can and should be removed, etc. Your surgeon will explain the
technique and incision placements or methods that may be most appropriate for you
and should discuss the risks associated with brow lift with you, as well.
You will also
discuss the available anesthesia that will be used for your procedure. Most brow
lift procedures are performed under either General IV Sedation or Light Sleep
Sedation. However, Regional or Local with oral sedation is a possibility. Either
way, discuss this beforehand as many people are not aware of the risks of
Anesthesia. If you do go under Deep General, ascertain that the anesthesiologist
is certified. Please read the All About
Anesthesia Page -- the risks regarding anesthesia should be considered for a
fully informed choice.
If you would like
more information on Consultations or a list of questions to ask your surgeon
please visit the Consultation Help Page.
you should choose to book or reserve a surgery date you will usually give a
deposit to hold your surgery date. Most times if you cancel a few days
beforehand, this amount is non-refundable. After paying your deposit and
scheduling a surgery date, you will also schedule a pre-operative appointment...
appointment addresses more questions you may not have thought to ask at the
initial consultation, such as more surgical details, concerns and even
ascertaining that your surgeon is aware of what you desire from your procedure.
Just as your surgeon will make certain that you know what it realistically
possible from this procedure.
You will also
discuss your pre-operative instructions and speak about the recovery period
instructions and what to expect in the months ahead. You will be given
prescriptions for antibiotics, pain relievers, perhaps blood pressure medicines,
prescription anti-inflammatory drugs and perhaps a box or directions for gaining
a bottle of Arnica montana. Perhaps you will
be instructed to obtain Bromelain or other types of remedies, although many
surgeons would rather have you not take ANYTHING other than your prescription
medications, please do not go against your surgeon's wishes.
Please do not
hesitate to address any concerns that you may have during this time and even
after your pre-operative appointment. If you remember something when you get
home or the next day or even the day of surgery -- don't be afraid to ask.
for Your Surgery
should be given a pre-operative information packet that explains everything you
should do and know before your surgery date. The packet should include a
list of all the medications you should not take starting usually at 2
weeks before your surgery. These medications will include, but are not limited
to, aspirin-containing products, stimulants, seratonin supplements, etc. Would
you like to view a typical Medication &
Supplements List? We have a printer-friendly
version as well. Also, if your surgeon advised that you may take Arnica
montana, Bromelain, Vitamin K, etc. for swelling and bruising you should either
have this in your packet or begin shopping for your necessities.
It is quite possible
that you will have "blood work" performed. This is normally an
extra out-of-pocket expense that the patient must participate in to check your
white and red blood cell count (called a CBC) and check for disease or disorders
beforehand. If you are a female they may take an extra vial for a pregnancy
test. Some surgeons ask that you have physical. This can be yet another out of
pocket expense so ask at your consultation what will be needed when you are
quoted a price.
It is really
important to quit smoking as soon as possible, if you presently do. When a
patient smokes three is decreased vascularization, circulation and healing.
can resulting in tissue necrosis (skin death), delayed healing, complications,
intense bruising, etc. Please consider these risks.
So many things to
do... so little time. Surgery will be here before you know it so visit the Preparing
For Surgery Page and relax. This section contains, printer-friendly
pre-op lists, tips and advice as well as things you must do to prepare for your
This Procedure Is Performed
Brow Lift normally takes from 1-2 hours to perform on its own. This
operation can be performed in conjunction with a face lift, eyelid surgery or by
itself. If you are having a face lift as well, your surgery will last closer to
First, you will be given your choice or your
surgeon's preference in anesthesia as discussed prior to your surgery date. If
you had been given an oral sedative or valium prior you usually could care less
what they are sticking in you. They will more than likely insert an IV for
a saline drip to keep you hydrated and have a vascular doorway
should the need arise. If you haven't been given a sedative, it is more
stressful for some patients. Having an IV inserted feels sort of like blood
being drawn, but for a shorter period of time. It's the initial placement of the
IV that may sting a bit. After the needle is injected into the vein it is pulled
out and a little plastic tube is left in your vein. This is called a
"catheter", which is taped to your skin so it is not knocked out and
is ready to be used as a sort of entryway for anything the surgical team deems
suitable for your body. This is usually done before you get into the actual O.R., by a nurse, and you have a saline bag hooked up to you. The medications will
usually be given with a drip system with this saline. As I said, the saline
will keep you hydrated both during and post-operatively.
Some people get heir IV placed
in the crook of the elbow, some the hand. I dislike the hand ones as it's a
nasty place for a bruise to be, at least with the arm you can hide it -- it all
depends upon your veins though. So if your veins are not very prominent
this can be a problem. Some patients
end up with an IV in the neck (very rare though). You
are then brought to the O.R. if you aren't on the table yet.
With an IV Liquid
Sedative, they will insert a hypodermic into your tube that you are attached to
or they attach the bag of it with a drip system to add a few drops every few
seconds and when they spring open the stopper and it starts heading towards your
body. The effects of the anesthesia are felt soon after injection or opening
the stopper -- a few seconds in fact. It feels like heat going
into you veins then creeping up your arm, then it "jumps" from your
shoulder to a metallic-like taste under your tongue and then you are blissfully
Your hair will
either be gathered into sections with small rubber bands or clips or trimmed and
shaved, depending. You will then be marked with a Sharpie type marker for the
incision placement areas. You will then be scrubbed with Betadine although the
surgical marker markings will remain, although not as dark. You will be injected with a solution of
saline, Lidocaine and epinephrine. The epinephrine is a vasoconstrictor
and will impede your ability to bleed excessively and it will hinder excessive absorption
of Lidocaine at the same time. The Lidocaine
is an anesthetic to hinder autonomic responses which are triggered when the body
knows it is being injured and also for pain relief post-operatively. Although some surgeons may use only the anesthetic and epinephrine.
The incisions will
follow along the surgical markings within the hairline, or in persons with
receding hairlines, in front of the hairline. The incision length and placement
will be dependent upon the type of brow lift you will be having. All efforts
possible should be made in order to achieve inconspicuous scars.
will then dissect
to separate or follow along natural lines of cleavage (as through connective
tissues from your underlying structure, depending upon the type of lift and
desired results. This is like separating the skin and muscle from your skull.
will then proceed to either excise excess, loose skin and suction or remove
excess fat manually, or possibly atrophied muscle. Underlying structures are
then suspended by permanent sutures or "barbs" if you are going this
route. Some surgeons work on one area at a time, some like to move back and
forth checking for possible asymmetries -- it is really a matter of preference.
The surgical team then performs a sponge and
instrument count and your surgeon will
then lift your skin to the desired level of lift after excising about 1 to 3 cm of
skin, depending and either apply a tissue glue or more than likely sutures and
surgeon will then apply a bulky dressing to your face and head to protect your
wounds, keep the tissue in the proper place during recovery and possibly as
pressure to help with swelling and prohibit displacement. This involves wrapping a dressing
around the top of your head to underneath your chin, sometimes slightly over
your ears. Of course there may be differences in surgical technique depending
upon the preference of your surgeon.
You are then gently
awakened and brought into the recovery room where the recovery nurse will
monitor your vital stats until you are ready to be released. This is dependent
upon the individual but may take up to two hours. Your face may feel tight and
quite tender as the anesthesia wears off. You may even feel emotional or upset
-- this will depend upon your body's reaction to anesthesia. You may also
experience "rigors" or shivering. This may feel uncontrollable and is
usually from the medications -- more than likely epinephrine that is used as a
vasoconstrictor. The recovery nurse usually has wrapped you in a warm blanket
but if not, request one. It certainly makes things more tolerable.
Some patients feel
nothing different although if you have had General you may feel a little sick -
hopefully your surgeon gave you something to lessen this. Your prescribed
medication should alleviate this pain and discomfort. However, if you believe
your pain to be out of the ordinary once you get home, call your surgeon or the
on call staff immediately. You will be driven home by your spouse, significant
other or friend as you will not be able to see, much less drive yourself home.
Road to Recovery
may get sick on the ride home from the surgical center or hospital so have a
bucket or can with a lid as well as water and some Ritz or Goldfish
crackers. Bring pillows and a blanket if need be. If you hurt take your pain
relievers. There is simply no reason to suffer. Besides studies have shown that
patients with increased pain heal slower than patients who are not in pain.
You may be groggy
from the anesthetic and or oral medications and probably won't remember much of
the first day or two. You will have to take it easy and sleep on two pillows to
keep your head elevated for about 14 days -- or however long your surgeon
suggests. A recliner is the best for this. When
you wake up you will notice that your forehead will look even more swollen in
the first 3 days. You
won't usually be very swollen until late that night or the next day and
then the third is by far usually the worst. But, as the days go on the swelling
will dissipate. There may be a lot of bruising, but this will go away, as well.
So make a mental note of this or you may be shocked into a depression. Bruising
and swelling are a normal occurrence in most surgeries. Don't worry, it is all a
part of the natural healing process. You shouldn't really look at yourself in
the mirror, but rather have your partner or nurse care for you instead (even
take photos if you wish it).
discomfort should be alleviated by your prescribed pain medication if you have
excessive pain, redness, pus or other symptoms that do not appear normal,
contact your surgeon immediately! Take your temperature regularly.
elevated temperature could mean an infection. Take those antibiotics on time.
Also, don't forget if you are a female taking birth control pills that some
antibiotics can interfere so in the event that you do have relations, use
another form of protection as well.
Your back will more
than likely cramp up from not being able to lie completely stretched out and
flat on your back so some patients prefer heating pads or hot water bottles.
Remember not to sleep while using any of these devices. This can result in
severe burns, especially if you are heavily medicated and don't feel the heat
You will go in the
next day more than likely for your first post-operative visit. The surgeon MAY
change your bandages or may wait until the end of the week -- depending upon the
seepage or the extent of work. Your sutures won't be removed until day 5
to 7 and
your staples in your scalp (if applicable) not until around day 10. Your scalp
takes longer to heal.
Your scalp will be
numb -- don't be afraid or worried, this is quiet normal, remember your nerves
and all have been partially separated from their source. Give them
time to recuperate, just as you, yourself, need time to heal. Please take it
easy and try not to do too much, too soon. You should be up and about in the
first few days but don't feel guilty if you don't. Listen to your body.
Even though you may
feel better, you must take it easy for the first 3 weeks. Be careful not to bend
over or lift heavy objects. Be careful not to raise the blood pressure for
at least 3 weeks as this could cause internal bleeding at your treatment area.
Your blood vessels dilate to allow increased blood flow when you raise your
heart rate. This may cause problems at internal wound sites. Do not
participate in contact sports for at least 6 to 8 weeks, although ask your surgeon
what he recommends specifically.
Please continue to
avoid alcohol and aspirin containing products for a few weeks (or until your
surgeon tells you) as this has anti-platelet properties and could cause
bleeding. Also you are going to be bruised and swollen for quite some time.
If you smoked before the procedure you really should not start back up.
greatly increases lack of vascularity promoting necrosis (death) of skin,
improper healing and excessive scarring. Quit beforehand and stay such.
I know it is difficult. I know, I smoked for 11 years and quit almost 5
years ago as of this publication.
You will notice a
change in your eyebrow's appearance, odd sensations of tightness,
tingling, the sporadic sharp pain, or "pulling", burning, and cold
sensations. These usually subside within the first few weeks. Your swelling
will subside, revealing a more defined, youthful, proportionate you. Although
this may take some time so please prepare yourself emotionally. Some patients
experience a lull or down period where they become depressed or feel
unattractive. This is very normal. Please print out our Emotional
Preparation Sheet so that you will be able to remind yourself that you
will get through your low period. Also realize that your eyebrows may appear too
raised, this too will passed if performed correctly.
& Complications of Brow Lift
Of course there is the
inherent risk regarding anesthesia and complications because of it -- such as
allergic reactions. Although please read the
for more information. Other risks may be hematoma, seroma,
asymmetry, infection, nerve damage, and tissue necrosis (tissue cell death).
A very common after
effect is Alopecia
loss of hair, wool, or feathers : BALDNESS]
along the incision lines and even hair of the head in general or facial hair,
such as eyelashes or eyebrows sometimes because of the anesthesia and
medications such as antibiotics and pain relievers. Only about 1% (source:
Rhytidectomy; Grand Rounds, Dept. Otolaryngology UTMB, 11/06/96)
report permanent Alopecia. This may be from individual bodily reactions,
circumstances or excessive tension. Sometimes a scar excision is suitable,
sometimes this will only create further tension.
Not all techniques
have the same drawbacks or pluses. With the coronal lift, the incision can
create a higher hairline. Some persons may not wish to have a more raised
hairline. With the Endoscopic brow lift, the result is more subtle and more
suitable for younger persons not wanting too much of a lift. There is also a
risk of a lift failure, per se, where the sagging brow returns to its prior
position, or elapses within a year of the surgery. This is most often
report with endoscopic brow
lifts. The risk of brow
asymmetry is a reality so be cautious when choosing a surgeon -- although it is
very possible that the variations in healing of the patient can affect this.
Usually, a minor touch up can be performed with local or regional anesthesia,
Please discuss with
your surgeon the risks of Brow Lift and his or her risk and complication
Least You Need to Know About Brow
lift or forehead lift.
reduce the furrowing of the brow, soften an angry or tired look. Also to ease the wrinkles of the
forehead or the furrows between the brow.
late 20's and upwards to mature patients
skilled plastic surgeon with a good background and experience in performing
Surgical Suite or hospital
upon the technique, from 3 to 4 small incisions to a full coronal incision.
Anesthesia: Read All About Anesthesia
Duration: 1 to 2 hours, depending upon extent of work to be done.
Factor: moderate, pain
meds should alleviate any discomfort. If not, call your surgeon immediately.
moderate, depending upon individual's bodily reactions
Bruising: mild to acute, depending upon
individual's iron levels, health, habits (smoking), and instructed
instructions: Have someone
there to help care for you during your recovery, keep elevated -- even when
sleeping. A recliner works best but several fluffy pillows are
Post-op visit: Although
next day and 3 day visits are not unheard of, they usually occur at 5 to10
visit: check up usually at 3 weeks for exercise/activity release or to
take staples out of the scalp. T hese stay in longer than standard sutures.
to work: usually within
10 days, but depends upon type of wok. Sedentary (desk job) with little or
no amount of talking. If your job requires high impact activity you may need
more time off, please ask your surgeon.
Activity: Usually no exercise until at
least 3 weeks post-operative. Be careful not to raise your blood
pressure for several weeks, you don't want to inhibit proper healing. Check
with your surgeon.
incisions out of the sun!
End result: usually
can be seen within 7 to 10 months, sometimes more.
Sensitivity: It is possible to
lose sensation along the incision lines, forehead and temporal area. Long
term or permanent loss of sensitivity is possible. Usually you will not
have feeling around your incision with the coronal incision for 5 to 7 months
eyebrow and eyelash loss from medications. Possible asymmetry as well.
from this procedure generally lasts from 5 to 10 years.
Disclose all your medical background. If you are a smoker, if you are taking
medications, or if you have any other medical concerns. Be realistic in your
expectations. No plastic surgeon can perform miracles, he or she can only
try and improve upon what you have beforehand.
prices: $2,130. -
$7,500. (depending upon
Mimi S. Kokoska,
MD; J. Regan Thomas, MD, The Subgaleal Endoscopic Browlift; Arch Facial
Plast Surg. 2000;2:202-208
Webster-Merriam Medical Dictionary
Yale Medical Core Curriculum - The Forehead Lift