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Brow Lift Surgery

Brow Lift Procedure in Newcastle & Maitland

 

Brow Lifts (or Forehead Lifts) are procedures that address the downward position of the eyebrows, which can contribute to the presence of excess skin in the upper eyelid area. When the brow is elevated, the skin between the eyebrow and eyelashes is redistributed, which may help to restore a more balanced eyelid contour.

 

About Brow Lift Surgery

 

As we get older, the elasticity and muscle tone around the eyebrows decreases due to muscle laxity and loss of collagen, resulting in a downward shift of the brow position. This is called Brow Ptosis.

 

As the brow descends and the ptosis progresses, the fat and skin beneath the brow can also shift lower, extending over the upper eyelid and contributing to Dermatochalasis, the excess tissue often removed during a Blepharoplasty procedure.

 

Unlike a Blepharoplasty, where tissue is excised, a Brow Lift involves repositioning the brows. Often, no tissue is removed unless the procedure is combined with a Blepharoplasty to address upper eyelid skin. In some cases, fat beneath the brow is reduced or contoured if it has become prominent.

 

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 areas, a Forehead Lift may be 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.  A Brow Lift is often better performed in a more subtle way gently elevating the brows, softening the frown lines and helping to maintain a natural brow position over time.

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.

browlifts-preface-cosmetic-endoscopic

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.

transbleph-image
transbleph-image

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-Diagram-Image

Thread Brow Lifting:

Aptos Threads are used for this procedure and the results can be modified to create a 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?

Like all surgical procedures, brow lift surgery carries risks. It’s important to be aware of common risks so you are able to weigh up the benefits, risks and limitations of the surgery. Below is a list of possible complications and specific risks for brow lift surgery. General risks and complications of surgery can be found here. There may be complications that are not listed here and some lifestyle factors and medical conditions can cause greater risks.

 

Risks of brow lift surgery:

  • Numbness in the forehead and scalp region
  • Brow asymmetry and brow ptosis
  • Haematoma formation
  • Loss of hair around incisions
  • Scarring
  • Changes in skin sensation

Recovery from a Brow Lift procedure.

The recovery and downtime will depend on the type of brow lift surgery. As with many procedures, surgical wounds usually take 1-2 weeks to heal. With an Endoscopic Brow Lift, there are no sutures to be removed, whereas other types of brow lifts such as a Transblepharoplasty Brow Lift, sutures are removed at that time or are often left to dissolve and absorbed by the body, which may take up to 8 weeks.

 

There will be some bruising and swelling, which generally subsides about 1-2 weeks after the operation. Keeping your head elevated, posturing and applying cold compress immediately after surgery are paramount in minimising pain and swelling. It may take up to 3 months for everything to settle down and swelling can persist over this period.

 

At Prèface Cosmetic we provide patients with tailored recovery programs to reduce post-operative bruising and swelling. This may include the use of LED lights or laser treatments to absorb blood from bruising. Silicon scar gels may also reduce scarring and platelet therapy can aid with healing and reduce persistent swelling. Followup visits with Dr. Hollenbach will ensure that any changes in circumstances and recovery are dealt with accordingly.

 

Swimming, physical exercise and heavy lifting is to be avoided for two weeks.

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, a lowered brow position can contribute to sub-brow fat ptosis, where the fat beneath the eyebrow shifts downward toward the lashes. This can often be addressed with a brow lift and targeted fat reduction, without the need to remove skin. 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, many 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.

What is the cost of a Brow Lift?

There are several factors that determine the cost of Brow Lifts. It depends on any adjunct procedures performed and 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.

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