Brow Lift

A brow lift, also called a forehead lift, can give a more youthful look to an aging face.

Anatomy of the Forehead and Brow

The shape of a person's forehead and brow line depends on the elasticity of facial skin and the underlying muscles and bone. Skin loses elasticity as it ages, contributing to the sagging, wrinkling, and drooping that make a person look older. The tissue underneath the skin also thins and changes, adding to the wrinkled or sagged appearance.

One result of the skin changes is that eyebrows begin to sag. Although the effect may not be pronounced, drooping brows can make a face look old.

Another sign of aging skin is wrinkles across the forehead. Tiny muscles beneath the forehead tug on skin with each smile and frown. Aging skin doesn't bounce back to normal; instead, it begins to settle into wrinkles and lines.

What a Brow Lift Targets

A brow lift targets the area just above the eyes. With age, eyebrows may begin to droop and horizontal lines may appear across the forehead. A brow lift can return the eyebrows to a firmer, more youthful appearance. It can also smooth out the forehead.

To see what effect this surgery might have, try placing the palms of your hands above your eyebrows, at the outer edges of your eyes. Press upward on your skin to raise the brow and forehead area. You should see a smoothing of forehead wrinkles and a moderate lifting of your eyebrows. This surgery will not correct excess skin overhang in the eyelids, which is another sign of aging.

How It's Done

There are two surgical methods, each giving approximately the same results. The traditional method involves an incision going from ear to ear, usually just above the hairline. This incision is easily hidden in women, whose hair will cover the scar. Balding men may do better with a higher, mid-scalp incision, which leaves a less conspicuous scar. After making the incision, the doctor reaches under the skin and cuts or alters the tissue beneath. This helps to smooth the forehead. Finally, the skin is pulled upward to raise the brow, any excess is cut away, and the incision is stitched or stapled closed.

A second method uses several smaller incisions in the scalp. The doctor performs the surgery by inserting an endoscope (a tiny camera) and surgical tools through the incisions. Stitches may be placed below the surface of the skin to lift the brow area and hold the skin while it heals. Endoscopic surgery is intended to leave smaller, less noticeable scars than the older method.

Both methods involve raising the hairline by at least a small amount, unless the incision is made below the hairline. This lower incision leaves a more noticeable scar, and hair must be worn forward to cover it.

Recovery

A brow lift is not minor surgery. While most people do well afterward, surgeons advise taking a week or more to recover before returning to work and normal activity. Full recovery, with all of the visible signs and physical symptoms gone, can take weeks to months.

Some pain and numbness are normal after the surgery. Forehead, cheeks, and eyes may all be swollen. As the numbness begins to go away, many patients experience scalp itching, which can continue for several months. Temporary hair loss around the incision is also common, but the hair almost always grows back normally within a few weeks or months.

Patients who have had endoscopic surgery usually have less intense pain, discomfort, and swelling. Itching is usually less of a problem, too.

Risks

Before choosing any surgical procedure, talk to the doctor about the risks. Possible complications of a brow lift include:

• Infection at the surgery site
• Permanent numbness of the scalp or forehead
• Permanent hair loss
• Raising of the hairline beyond what looks normal
• Uneven eyebrows
• Brows lifted too high, giving a "surprised" look

Alternatives

Surgery may be the best choice for sagging brows, but it's not the only way to treat forehead lines. Other choices include Botox injections and collagen fillers. Fine lines can often be minimized with wrinkle creams and microdermabrasion.

Finding a Surgeon

Look for a surgeon with lots of experience and good results. Ask to see photos of previous patients. If possible, talk to some of them to make sure they are satisfied with the results.

If you'd prefer one surgical method over the other, make sure your surgeon is comfortable with that method. Also check to be sure your surgeon is certified by the American Board of Plastic Surgery, or by the equivalent organization in the country where you live.