Brow Lift

A brow lift helps to correct the frown lines (that develop between the eyebrows) and wrinkles on the forehead and nose bridge and raise the eyebrows for a youthful appearance. It is also known as a forehead lift.

The brows and forehead are the first areas on the face to develop signs of ageing. An ageing forehead can affect facial expressions; for example, heavily furrowed, sagging brows can make you look angry, tired, or worried even when you are not. Some people have low, heavy brows or furrowed lines due to repeated muscle activity, stress, or genetic factors. Cosmetic surgeons suggest a brow lift in such individuals to reduce signs of ageing and provide a youthful appearance to their face. The surgery achieves these goals by elevating the brow and improving the forehead wrinkles and frown lines.

Brow lift may be performed in isolation or conjunction with other restorative procedures, namely facelift, upper/lower eyelid surgery, or skin resurfacing techniques.

Brow lift is recommended to improve the facial appearance in individuals with one or more of the following:

• Creases, furrows, and wrinkles on the forehead
• Excess skin in the upper eyelid or above the eyes Read more: Drooping eyelids causes
• Wrinkles on the nose bridge
• Vertical creases between the eyebrows (frown lines)
• Drooping or sagging brows
• Brow asymmetry

You will be a good candidate for the surgery if you are physically healthy, a non-smoker (or have discontinued smoking), and have realistic expectations from the surgery.

A surgeon may choose not to perform this surgery if you have medical problems that may:

• Affect postoperative healing
• Increase the risk of postoperative complications
• Contraindicate the use of anaesthesia

You will need to visit the hospital prior to the surgery for a preoperative consultation wherein the surgeon will take photographs and measure and evaluate different sections of your face. Moreover, he/she will examine the elasticity, texture, and colour of your skin. Subsequently, you will be asked to undergo the following tests:

• Blood test
• Urine tests
• Pregnancy test
• X-ray
• Electrocardiograph (ECG)

During the consultation, you will need to share the following details with the doctor:

• Your medical history
• Coexisting health conditions
• Tobacco, alcohol, and drug use
• Allergies
• History of anaesthesia
• Your current list of medicines, including herbs, vitamins, and over-the-counter medications
• Expectations from the surgery

You will be given the following instructions to prepare for the surgery:

• Discontinue blood thinners like ibuprofen, aspirin, warfarin, and naturopathic substances (such as ginseng and garlic) a few days/weeks before the surgery.
• If you are smoker, the surgeon will ask you to stop smoking.
• Arrange for a friend, family member, or responsible adult to drive you home after discharge from the hospital.
• Remove all the make-up, body piercings, and nail polish before you arrive at the hospital on the day of the surgery.
• Inform the surgeon if you develop a cold, flu, or fever in the days leading to the surgery. In such a case, your surgery may be postponed.
• You will be required to fast from midnight prior to the surgery. Fasting is recommended to prevent vomiting (risk of general anaesthesia) during the surgery.

The surgeon will share the details regarding the type of anaesthesia used, procedure, and risks associated with the surgery. If you understand the details and agree to the surgery, the surgeon will ask you to sign a consent form.

After admission to the hospital, the hospital staff will provide you with a hospital gown. They will also insert an intravenous (IV) line in your arm or hand to supply essential fluids and medicines. The following steps will be taken during the surgery:

• Anaesthesia: The surgery will involve one of the following anaesthesia options:
  • Local anaesthesia and IV sedation (you will be awake during the surgery)
  • General anaesthesia (you will be in a deep sleep during the surgery)
• Procedure: The surgeon will make one of the following incisions to access the tissue and muscles of your forehead:
  • Coronal incision: This is a classic approach wherein the incision extends from one ear to another from over the top of the head.
  • Pretrichial incision: In this incision, a cut is made near the front hairline of the forehead.
  • Endoscopic incision: Compared to the other techniques, this is a minimally invasive approach wherein several tiny incisions are made within the hairline. The surgeon will insert a tube fitted with a camera at one end (endoscope) through the incision along with other special instruments to make changes to the forehead and eyebrow.
• After making an incision (cut) on or around your forehead, the surgeon will: 
  • Adjust the muscle and tissue below your skin
  • Lift the skin of your forehead
  • Trim excess sagging skin
  • Remove tissue and skin as needed
  • Elevate your brow
• Closing the incision: The surgeon will close the incision/incisions with absorbable or non-absorbable stitches. He/she may also use skin adhesive and special clips to close the wounds. The incisions and forehead will be taped or loosely wrapped with a dressing.

After the surgery, the surgeon will insert a tube in the operated area. This will help drain accumulated fluids or blood beneath your skin. If the surgery is performed under general anaesthesia, you may feel restless, tired, or groggy and have a dry mouth or sore throat upon waking up. These are side effects of general anaesthesia that usually fade within a few hours.

The surgeon will give you discharge on the same day of the surgery; however, you may require a short hospital stay.

Your dressing will be removed one to two days after the surgery. You may be able to eat a light meal and drink liquids after two to three hours of surgery. 

It is normal to observe the following side effects after the surgery:

• Bruising and swelling that may extend to the eyes and cheeks
• Numbness around the incision or on the top of the scalp
• Minimal pain and discomfort around the operated site
• Itching in the scalp

Although the initial healing of the wound may complete in 10 to 14 days, the healing process will continue for several weeks. 

You will need to take the following care during the recovery period:

• The surgeon will prescribe medicines to provide relief from the postoperative pain.
• Keep your head elevated with a pillow when you are lying down. 
• Do not apply heat or ice on the operated area.
• Do not resume swimming, strenuous exercises/sports, heavy lifting, or other similar activities without consulting your surgeon.
• Do not subject the incision to excessive force or motion during the recovery period.
• You can apply cosmetics to conceal any postoperative bruising on the forehead and other operated sites.
• Maintain a healthy lifestyle, minimise exposure to sun post-surgery, and apply sun protection to prolong the results of the surgery.

You can restart normal activities and work two weeks after the surgery. The surgery will rejuvenate your eyes, create a smoother brow, and smoothen the wrinkles on your forehead to give you a youthful and rested appearance. Although the surgery has immediate effects, they may not be visible due to the postoperative swelling. It may take some months for the swelling to subside completely and final results to appear. Most individuals experience a satisfactory result following the procedure, however, it cannot be guaranteed.

When to see the doctor?

Contact the surgeon at the earliest if you experience any of the following symptoms:

• High body temperature (>100.4^°C)
• Chills
• Increased pain, redness, or tenderness around the operated area
• Heavy bleeding from the wound

Some of the risks/complications associated with the surgery include:

• Hair loss around the incision
• Nerve injury
• Pruritus
• Brow asymmetry
• Eye problems
• Infection in the operated site
• Pain and numbness in the wound
• Bleeding from the incision
• Formation of blood clots
• Difficulty emptying bladder
• Risks of anaesthesia such as confusion, stroke, or lung infection
• The requirement for a revision surgery

Your surgeon will provide you with a schedule for follow-up appointments before discharging you from the hospital. The drainage tube, if inserted post-surgery, will be removed one to two days following the surgery. If non-absorbable stitches are used to close the incision, they will be removed in one of the follow-ups conducted one week after the surgery.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.