Brow Lifts

Brow Lift Procedure

 

Brow Lifts (or Forehead Lifts) are helpful when there is droopiness of the eyebrows, which can accentuate the appearance of excess skin around the upper lids. When the brow is lifted the excess skin between the eyebrow and the eyelashes is less bunched up and the face appears fresher.

 

About Brow Lifts

 

As we age and lose collagen, the support needed to maintain our youthful appearance is lost and our faces begin to sag due to the unopposed effects of gravity.

 

This is most evident in our brows. As we get older the elasticity and muscle tone around the eyebrows is lost because of laxity of muscle and loss of collagen and the brow begins to sag.  This is called Brow Ptosis.

 

As the brow sags and the ptosis gets worse, the fat and skin beneath the brow begins to go south, encroaching on the upper eyelid skin and exacerbating Dermatochalasis which is the tissue removed during a Blepharoplasty procedure.

 

Unlike a Blepharoplasty where tissue is removed, a Brow Lift involves lifting the brows and often no tissue is removed at all unless combined with a Blepharoplasty where upper eyelid skin is removed. Sometimes the fat beneath the brow is removed if it has sagged. This is known as Sub-Brow Fat sculpting.

 

Our Forehead As We Age

 

In addition to Brow Ptosis, the forehead also changes with age.  Deepening of the furrows of the forehead, often called Forehead Lines, and also deepening of the furrows at the top of the nose in what is known as the glabellar region occurs. More laterally towards the outside of the eyelids, crow’s feet also become more noticeable.  To treat these problems areas, a Forehead Lift is required which is basically an extension of a Brow Lift.

 

A Forehead Lift and/or a Brow Lift can be overdone giving the appearance of a startled look or a “deer in the headlights” look.  This is most unattractive and needs to be avoided.  A Brow Lift is often better performed in a more subtle way with gently elevating the brows, gently softening the frown lines and preventing the brows from further sagging.

Brow Lift Procedures

 

There are three main types of Brow Lifts performed by Dr Hollenbach at Prèface Cosmetic. All of which may be combined with Blepharoplasty and/or Sub-Brow Fat Sculpting.

Endoscopic Forehead Lift:

An Endoscopic Forehead Lift basically lifts the forehead from above the hairline using bio-integratable Endotine anchors which are fixed to the bone above the hairline and the whole forehead and brow complex is lifted and tightened.

 

This is done through Endoscopic keyhole surgery and is obviously an involved procedure requiring a general anaesthetic and is done in a private hospital.  The anchors are bio-integrated into the tissues with time forming a scar in the deeper tissues behind the hairline so it is not noticeable but this fixates the brow which can maintain this position for years to come.

 

Down time – 2 – 3 weeks.

Transblepharoplasty Brow Lift:

This is the most common form of Brow Lift performed by Dr Hollenbach at Prèface Cosmetic.  It is always combined with a Blepharoplasty and the incision is that of the Blepharoplasty itself with further dissection up into the forehead. Endotine anchors during this procedure are fixated to the bone just above the eyebrow in a new position.

 

The brow is lifted but not to the same degree as with an Endoscopic Brow Lift.  Although the forehead is mobilised during the surgery, it is not lifted as with an Endoscopic Brow Lift and therefore is not a procedure that is done when softening of frown lines is needed.  In this case, an Endoscopic Brow Lift is the procedure of choice. A Transblepharoplasty Brow Lift is considered more to be a brow stabilisation procedure with just a subtle lift.  Once again Endotine anchors are bio-absorbable forming a scar above the eyebrows which is not seen and will ensure that the brows are stabilised for years to come.  This procedure can be performed under general anaesthesia in a private hospital or under local anaesthetic in Dr Hollenbach’s rooms.

 

Down time – this is the same as a Blepharoplasty, around two weeks.

Transblepharoplasty Brow Lift:

This is the most common form of Brow Lift performed by Dr Hollenbach at Prèface Cosmetic.  It is always combined with a Blepharoplasty and the incision is that of the Blepharoplasty itself with further dissection up into the forehead. Endotine anchors during this procedure are fixated to the bone just above the eyebrow in a new position.

 

The brow is lifted but not to the same degree as with an Endoscopic Brow Lift.  Although the forehead is mobilised during the surgery, it is not lifted as with an Endoscopic Brow Lift and therefore is not a procedure that is done when softening of frown lines is needed.  In this case, an Endoscopic Brow Lift is the procedure of choice. A Transblepharoplasty Brow Lift is considered more to be a brow stabilisation procedure with just a subtle lift.  Once again Endotine anchors are bio-absorbable forming a scar above the eyebrows which is not seen and will ensure that the brows are stabilised for years to come.  This procedure can be performed under general anaesthesia in a private hospital or under local anaesthetic in Dr Hollenbach’s rooms.

 

Down time – this is the same as a Blepharoplasty, around two weeks.

Thread Brow Lifting:

Aptos Threads are used for this procedure and the results can be modified to create a totally new contour of the brows.  The threads are inserted in the subcutaneous tissues so that it is really only the skin of the eyebrows that are lifted rather than the whole complex.

The longevity of this procedure therefore is limited.  The threads absorb in about a year and if the brow begins to sag, which usually happens after two or three years, the procedure can be readily repeated.  Thread Brow Lift is performed in Dr Hollenbach’s rooms under local anaesthesia. After the procedure the brow is taped for a week to help immobilise the area allowing the threads to ‘set’ in the desired position.

 

Down time – 7 to 10 days.

What are the risks involved with Brow Lifts?

Dr Hollenbach has been doing Oculoplastic surgery in excess of twenty years and has performed many Brow Lifts. Dr Hollenbach has gone through an evolution of the procedure trying many techniques.  The techniques he has settled on now are tried and true and have minimal risks.  There are however individual idiosyncrasies and differences between patients and risk assessment need to be conducted thoroughly preoperatively.  Any surgical procedure, including any Oculoplastic procedure such as Brow Lifts, comes with risks which should not be trivialised.  Dr Hollenbach has a very low rate of complications during the procedure and rarely has to do any repeat surgery due to any adverse outcomes.  Of course, if there is an adverse outcome in any way Dr Hollenbach will do everything to rectify this to make sure that you are very satisfied with the result.  You will be looked after post operatively and nursed through the healing period using the healing aids previously discussed.

 

Dr Hollenbach frequently gets referrals for patients who have had Upper Eyelid surgery or Brow Lifts to redo the procedure or at least to counsel you in regards to any problems that you have encountered.  As an Oculoplastic surgeon Dr Hollenbach will assess your eye function fully before and after surgery and do everything to make sure that you have the cosmetic result that you have desired and in particular not to overdo the Brow Lift and make sure you do not have that startled “deer in the headlights” look which can be very unfortunate after Brow Lifts done by less experienced surgeons.

Who is an ideal candidate for a Brow Lift?

This procedure is suitable for men and women as a cosmetic procedure over the age of 35.  There are also instances of Brow Ptosis associated with facial palsy or facial trauma where the procedure is non-cosmetic, but the same principles apply.

 

In general, a Brow Lift procedure does not involve any noticeable scarring.  The keyhole incisions for a Forehead Lift are behind the hairline and for a Transblepharoplasty Brow Lift the incision is that of a Blepharoplasty and is hidden by the eyelid folds.  Thread Brow Lifting can leave some temporary dimpling which usually resolved over a period of weeks to months, but often there is no noticeable indication that any procedure has been performed after the early post-operative period.  For those patients who have previously had Dermal fillers or Anti-Wrinkle injections around the brow or forehead area, Brow Lifting is a much more permanent and satisfying procedure.  Brow Lifting can be incorporated with Fraxel re:pair laser resurfacing and further collagen rejuvenating treatments.

 

Endotine Brow Lifting ensures a minimally invasive procedure which results in smaller incisions and less scarring than some other methods of Brow Lifting.  Post operative recovery time is reduced and there is less pain, swelling and bruising.  Endotine implants are natural and made from a substance called Polylactic acid which is produced by plants.  The result is that of a natural, revitalised appearance which does not look overdone. There are no visible scars after this procedure.

The difference between a Brow Lift and Blepharoplasty

As previously mentioned these procedures are very different from each other.  Patients with excess upper eyelid skin often come in requesting a Blepharoplasty type procedure to remove the skin.  Whilst this is often the right procedure, sometimes a Blepharoplasty combined with a Brow Lift or even a Brow Lift alone is more suitable.  It is not always excess eyelid skin which gives a heavy appearance of the upper lid.

 

Sometimes it is the brow droop causing Sub-Brow Fat Ptosis where the fat beneath the eyebrow droops towards the lashes. This can be readily addressed with a Brow Lift and fat sculpting where taking skin is unnecessary.  Furthermore, if there is Brow Ptosis in addition to Dermatochalasis, lifting the brows will require less skin to be removed as part of the Blepharoplasty procedure, otherwise if too much skin is removed the eyelids cannot close properly after the procedure.

 

Dr Hollenbach will assess this and give you his appropriate recommendations.   It should be noted that if a Brow Lift is recommended as well as a Blepharoplasty, but only a Blepharoplasty is performed, it is difficult to do a Brow Lift down the track as there is already a paucity of eyelid skin left and lifting the brow any further will make it difficult to close the eyelids which precludes any further surgery.  To put it more simply, if a Brow Lift is needed as well as a Blepharoplasty this is best done at the first Blepharoplasty procedure rather than thinking it is something that can be addressed down the track.

Why is an Oculoplastic surgeon the best type of surgeon to perform a Brow Lift?

As with a Blepharoplasty it is important that a thorough knowledge of brow and forehead anatomy is undertaken and this is the area of expertise of an oculoplastic surgeon.  Although many plastic surgeons perform Brow Lifts, they do not consider eye health as part of their work up when assessing patients when undertaking a Brow Lift in conjunction with a Blepharoplasty.  It is important that the eyelid closes adequately after the surgery immediately post operatively and more importantly once the tissues have healed. There have been many instances where browlifts have been undertaken in the wrong hands and are combined with the removal of too much skin of the upper lid and the eyelid does not close properly leading to corneal ulceration and other serious eye problems.

 

The advantage of an Oculoplastic surgeon such as Dr Hollenbach is that the eye health is adequately assessed preoperatively, including vision, the health of the tear film which is paramount for eye health and comfort and also of course to ascertain how much skin can be safely removed or how high the brow can be lifted without there being any long term detrimental effects.  It is common to have difficulty closing the eyelid in the first week or two after surgery and again an oculoplastic surgeon is the ideal surgeon to help keep the eye comfortable during this period using appropriate lubricants and other treatments.

 

Often the brows are taped up for a few days after the procedure making it difficult to close the eyelids for the first week or so after the surgery and it is important that the appropriate eye medications are prescribed at this time.  There are many instances in this type of surgery where, if these measures are not attended to, the eye is very uncomfortable and red.

 

You can be sure you are in safe hands when seeing Dr Hollenbach, who is a Fellowship and subspecialty trained Oculoplastic surgeon who has been performing Brow Lifts for many years and will make sure your eyes stay comfortable after the procedure and will use his expertise to minimise any post operative problems.

Recovery & post operative care following a Brow Lift

Post operative care is paramount and we pride ourselves in this area.  Dr Hollenbach will see you frequently after the surgery to help you with any questions or concerns.

 

As mentioned previously, the downtime for a Brow Lift procedure is typically between one and three weeks depending on the type of lift. Of course, general measures immediately after surgery such as elevation, posturing, use of ice packs are paramount. Swimming, exercise and heavy lifting are to be avoided for two weeks and mineral make up can commence a few days after surgery if you so desire.

 

At Preface we have various measures to reduce post-operative bruising and swelling including the use of LED lights, laser treatments to absorb blood from bruising and other various cosmeceuticals to aid healing.  We also use silicon scar gels to reduce scarring and platelet therapy  which can aid with healing and reduce persistent swelling as well as dealing with the crows feet, improving the texture and tone of overlying skin.

 

With an Endoscopic Brow Lift, there are no sutures to be removed. With a Transblepharoplasty Brow Lift, however, the suturing is that of a Blepharoplasty and these sutures maybe removed after the surgery or left to dissolve over a period of 6 to 8 weeks.

What is the cost of a Brow Lift?

The cost of Brow Lifts depends on whether there are any adjuvant procedures performed and of course depends on the type of brow procedure itself.  These costs will be given to you at the time of the initial consultation and should be discussed further with Dr Hollenbach.