Eyebrow Lifts
What happens at surgery?
Brow lift surgery can be performed under local anaesthesia, local anaesthesia with sedation by an anaesthetist ("twilight anaesthesia), or under general anaesthesia. There are a variety of surgical procedures which can be used to raise eyebrows. These will be discussed with you and the one selected will be that which is most appropriate to your age, appearance, and problems.
The procedures include:
- The direct brow lift
- The temporal direct eyebrow lift
- The endoscopic brow lift
- The transblepharoplasty (internal) brow lift
- The coronal forehead and brow lift
- The pretrichial forehead and brow lift
The direct brow lift involves the removal of redundant tissue just above the eyebrow and is mainly used in older patients with a marked brow ptosis (brow droop). The scars are visible but mimic forehead creases once completely healed.
A temporal direct brow lift is useful for a patient who requires a moderate lift of the outer aspect of the eyebrow only. The incision is confined to the outer aspect of the eyebrow only. This is suitable for most patients over the age of 50.
An endoscopic brow lift is used for moderate degrees of brow ptosis in patients usually aged 40-55. It is more time-consuming and more expensive. It can cause more postoperative pain, headache and discomfort than less invasive procedures. It leaves small scars just behind the hairline. It is generally unsuitable for patients with hair loss or thinning of the hair or with a very high hairline and prominent forehead.
A transblepharoplasty (internal) brow lift is performed in conjunction with an upper lid blepharoplasty. The brow is released internally from its local attachments and sutured to the lining of the bone (periosteum) just above the brow with a nylon suture. The brow is not raised significantly but is prevented from becoming droopy following the upper lid blepharoplasty. This procedure often leaves a temporary area of numbness at the outer aspect of the brow and a tender swelling around the brow suture for a few weeks.
Alternatively the tail of the brow can be raised with this approach by placing an Endotine implant in the bone underlying the brow. This implant is effective for patients who have a mild to moderate degree of brow ptosis. The implant dissolves after about 9 months by which time the brow has healed into the elevated position. The implant does, however, add expense to the procedure. The results of the surgery are maintained by 3-4 monthly Botox injections to weaken the brow depressor muscles.
The coronal forehead and brow lift is the most invasive approach to brow lifting. This involves an extensive incision running across the scalp either just in front of the hairline (pretrichial incision) or a few centimeters behind the hairline. Although considered rather out-moded this approach is still required for patients with a marked brow ptosis who are unsuitable for alternative approaches.
The disadvantages of this approach are the scar and numbness of the scalp behind the scar which extends to the centre of the scalp.
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