Brow Lift

What is a brow lift?

Brow lift or eyebrow lift is a plastic surgical operation that is aimed to improve the aesthetics of the eyebrow. This surgical operation, repositions the hair bearing eyebrow using sophisticated techniques performed with surgical precision and aesthetic finesse by minimal or remotely placed scars with low morbidity.  The patient benefits are it reverses age related brow descent, improves eyebrow aesthetics, improves and softens forehead lines and converts a tired or angry expression into a rested, contented look.

 

What defines eyebrow aesthetics – height, shape and contour

The height of the eyebrow and its shape together with the volume and contour define eyebrow aesthetics.

 

An ideal eyebrow 

Brow position varies with sex, age, and ethnic background and the ideal brow position varies according to fashion and culture.  The position of the brow is judged based on its relationship to the supraorbital rim (eye socket rim).  

 

Medial (inner) eyebrow is at or below the supraorbital rim ( eye socket rim) and there is a gentle upward slant outwards where the brow peak terminates above the lateral limbus of the iris and then tapers down so that the lateral end (outer end ) of the brow is at a higher level than the inner (medial) end.

 

Younger patient have a medial (inner) brow that is low with an apex arching upwards and outwards. Older patients have a raised medial (inner) brow and middle brow which contributes to a flattened appearance. A low brow position is associated with a tired and unhappy appearance.  

What are the visible signs of ageing in the eyebrow and forehead?

• Muscle imbalance cause forehead wrinkles, frown lines, medial eyelid folds and lateral Crow’s feet wrinkles. 
• The youthful contour of the eyebrow flattens with age
• In some cases, the eyebrow elevates due to chronic activation of the forehead muscle to overcome gravitational descent and to compensate for the restricted visual field cause secondary to the eyelid levator muscle disinsertion. An over elevated brow creates a surprised and unintelligent look.
• In some cases, the brow is lower, and a low position is associated with a tired and unhappy appearance.  
• Lateral brow hooding due to gravitational descent.

 

Lateral brow hooding or eyelid hooding.

Gravity acts on the soft tissue of the forehead and the temple and tend to pull it down. The frontalis muscle of the forehead will contract in an attempt to counter the downward force of gravity. The visible forehead wrinkles are a result of underlying muscle overactivity or spasm, but the temple area, there is no muscle that can counter act the gravitation aided downward descent of soft tissue. This ultimately results in hooding.

 

Eyebrow ptosis or eyebrow droop is worse in the outer half of the eyebrow segment as the outer (lateral) eyebrow has less support and the gravitational forces selectively depress the outer brow.

How does a droopy brow affect the upper eyelid and impact on the visual fields?

A droopy brow will restrict your visual field. This can be tested by your optometrist using standard visual field testing as a part of your pre-operative workup. If you have visual field restrictions due to a droopy eyebrow you may be eligible for cover if you have private health insurance.

 

Benefits of browlift

1. Improves your appearance
2. Improves your visual field and improves your functioning
3. Reduces headaches and the feeling of heaviness in the eyelids
4. Reduces hooded eyelids.

Is a browlift worth it? 

According to www.realself.com 91% said a brow lift was worth it. Realself.com based this on 107 ratings and this information was last updated on 24 May 2020.

 

Which muscles are responsible for the position of the eyebrow?

The muscles of the forehead, eyebrow and eyelid control the position of your eyebrow. Brow position is a result of the balance between two forces acting in two opposite directions. The upward and outward pull of the forehead muscle (Frontalis) and the downward pull of the eyebrow and eyelid muscles (Procerus, Corrugator and Orbicularis Oculi, depressor supercilii). 

 

Why does the eyebrow position an important consideration in eyelid surgery?

The eyebrow and the upper eyelid are both are interconnected and should be assessed as one aesthetic unit. Age related changes of the eyebrow such as eyebrow descent or eyebrow ptosis is an important piece of the puzzle of facial ageing and contributes to the hooding of the upper eyelid which in turn weighs down the upper lid and restricts the visual field. 

It is intuitive to remove the excess eyelid skin causing the hooding to restore the upper lid crease to produce a more youthful and alert appearance. The success of the eyelid surgery or blepharoplasty will depend on the state of the eyebrow. If eyelid surgery or blepharoplasty is performed when eyebrow is “loose” and ‘droopy’, without first firming the brow area, the brow may drop and the upper lid skin folds will recur after surgery.

 

Who is an ideal candidate for a brow lift?

Patients who complain of upper eyelid heaviness, eyebrow and eyelid hooding, saggy and droopy eyebrows and drooping or sad corners of the eyes.

 

Are there any non-surgical options for a brow lift?

Nonsurgical methods using toxins and dermal fillers sometimes referred to as ‘Botox brow lift’ can be effective if the changes are mild especially in younger patients. Non-surgical techniques using neurotoxin and dermal fillers are a good option to for maintenance therapy following a surgical brow lift.

 

Customising a brow lift

A brow lift has to be customised to suit every individual and it depends on the age of the patient, whether the patient is a male and female, whether the person has a receding hairline or not, and whether the ageing changes are mild or severe. 

 

Can a brow lift be performed on its own or should it be combined with other procedures

Browlift is more likely to be combined with either eyelid surgery or a facelift operation, and sometimes Botox and fillers are combined to rejuvenate the forehead.

Maintenance therapy using medical grade skin care is desirable.

 

What happens at the consultation for a brow lift?

During the consultation the position of the eyebrow, the changes in the forehead and the upper eyelid skin with special attention to wrinkles and excess skin are evaluated.

The aim of facial cosmetic surgery is to rejuvenate all areas of the face so that transition between the zones of the face is harmonious which is a hallmark of the youthful face.

 

What are the types of Brow lift?

A skilled Plastic Surgeon will use precise and predictable techniques for temporal brow lift to give you natural results and a refreshed look.

1. Endoscopic Brow Lift
2. Lateral Temporal Brow Lift
3. Direct Brow Lift

 

Endoscopic Brow lift

In certain cases, very small incisions can be made behind the hairline, the brow and forehead lifted upward, and then fixed with different fixation devices done endoscopically. 

 

Temporal Brow Lift or a Lateral eyelid lift

Through a small incision on the temporal hairline, the lateral temporal brow lift affords excellent repositioning and lateral brow elevation. It is best suited for individuals who have aging limited to the lateral brow.

In females, temporal lift incisions are placed behind the hairline to enable lift the brow and smooth the forehead area. 

In people who have receding hairlines, very thin incision can be made at the edge of the hairline to smooth the forehead, lift the brow, and actually bring the hairline forwards some. The hairline incision line is usually imperceptible. 

 

Direct Brow Lift

It offers excellent brow elevation through the direct excision of the redundant skin.  The best candidates are older individuals with heavy lateral brows and deep transverse forehead creases where the scar can be hidden. Ideally suited for males who are more likely to have lateral brow hooding

What happens after the brow lift operation?

If the brow lift is performed in conjunction with eyelid surgery or other facial aesthetic procedures, the patient usually stays overnight. The patient is kept comfortable with the head elevated and an ice pack over the eyes. Every effort is made to control nausea, pain and blood pressure.  If required appropriate medications are prescribed.  The next morning the patient goes home.  The patient is advised to keep the head elevated and to avoid strenuous activity for 6 weeks. 

 

Brow lift complications

Patient acceptance of this procedure has been high. Mild hair loss, numbness and temporary nerve paralysis are some of the complications.  

 

Temporary facial nerve paralysis is seen in less than 1% of patients.  Recurrence of brow ptosis is very rarely encountered and if so, reoperation is usually effective. 

 

Reducing risks of surgery

Healthy patients who choose a registered Specialist Surgeon in Plastic Surgery instead of a low-priced doctor who is not registered as a specialist, can reduce some surgery risks by:

• Making sure the Surgeon is experienced with significant expertise =
• Carefully following instructions before and after surgery
• Not trying to do too much too soon

An integrated skincare helps to maintain results of the brow lift

To get the best results of surgery, it is important to have a proper skin care regime integrated into your surgical plan that you can start before and continue after surgery. 

It is important to realise that the brow and all the supporting soft tissue and underlying bony will continue to age. So, it is a good idea to maintain the results using Botox, filler and medical grade skin care

Comment from Dr Naveen Somia, Plastic Surgeon and ``Sydney’s eyelid surgery expert:

“I believe brow and eyelid surgery are transforming, and yet these surgeries are very complex.  It’s much better to get it right the first time. When you choose a Plastic Surgeon, who is focused on eyelid surgery, you’re in far better hands in terms of experience, expertise and precision.”