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Procedure: Browlift

Author: Patrick Byrne, MD FACS

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Browlift

Browlift

A browlift is a procedure that is performed to elevate the eyebrows.  Lifting low eyebrows can make the eyes appear larger and more open, create a more beautiful shape to the brows, and lesson the lines and wrinkles of the forehead. These changes can produce a remarkable effect – particularly if done in a skillful manner to produce a subtle and natural appearing result. It is most commonly performed in men and women in their 50’s, 60’s, and beyond. The brows must not be lifted too much so as to avoid an unnatural, surprised look. This can be avoided by careful surgical technique.

 

A browlift can be performed in several different ways. In this article, we will describe the browlift – who is a candidate (and who should avoid it), how it is done, and what to expect.

 

Anatomy

The eyebrows are a very important part of the overall facial aesthetic. The ideal brow sits above the rim of bone of the eye socket (the orbital rim), with an arch that has its highest point above the outside half of the eye. In men, it tends to look best at the level of the orbital rim, or perhaps just a bit above. The brows in men tend to be flatter and less arched.

 

When the brow sits lower than the ideal position, the eyes appear more crowded and less attractive. In most people the brows tend to fall and deflate with age.  A related change is the development of excess, hanging skin of the eyelids. This sagging skin makes the eyes (and face) appear tired and old. There addressed separately through a surgical procedure which removes excess skin from the eyelids known as a blepharoplasty. In some cases the brows are low and there is excess skin of the eyelids. In this common scenario, a browlift is necessary to lift the brow in conjunction with an eyelid lift.

 

The eyebrows play an important role in facial expression. They are lifted up by our forehead (frontalis) muscle and are pulled inward and downward by the frown muscles. These muscles can be targeted with a neuromodulator (Botox/Dysport/Xeomin) to make the area between the brows softer and more rested looking. A browlift tends to accomplish this even better.

 

Who is a Candidate for a Browlift?

Anyone with tired appearing eyes, with sagging brows and/or eyelid skin, may be a candidate for a browlift. There are some people who shouldn’t have it done, however. These could include those who have trouble closing their eyelids because of previous skin cancers of the eyelids, or facial paralysis (although most of these patients are actually excellent candidates for browlifting), or people with troublesome dry eye symptoms.  

 

Anesthesia

 

Most of these surgeries are done in an operating room under anesthesia – either twilight or general anesthesia (where the patient is completely asleep).

 

Incisions and Approaches

 

There are several different types of Browlift approaches, each with different locations for the incisions.

 

Endoscopic Browlift

This is a minimally invasive technique which has been very popular for many years. It is typically done in people without significant hair loss, so the incisions can be hidden in the hairline. It does elevate the hairline a bit, but this tends to be so minimal that it does not bother people.  Usually, a total of five small incisions are made in the hairline.  A telescope (endoscope) is inserted through one of the incisions, allowing the surgeon to see the anatomy on a television screen as she/he releases the attachments of the forehead all the way to the eyebrows. The use of the endoscopic camera, along with specially designed instruments, allows this to be fairly easily performed despite the very small incisions. Once the tissues are released, the brows and forehead are lifted to the desired position, and fixated. The tissue can be fixated in a number of different ways, according to the surgeon’s preference.

 

Open Browlift Techniques

These procedures have longer incisions and are somewhat more invasive. They may have the advantage of being able to treat the horizontal lines of the forehead better. They can produce predictably good results in the right hands. There are a number of locations where the corresponding incisions can be placed:

 

Coronal:

The incision is made in the scalp within the hair. This hides the scar well but does elevate the hairline and can cause permanent numbness of the scalp.

 

Pre-trichial:

The incision is made just at the edge of the hairline. No elevation of the hairline occurs, but it does run some risk of creating a visible scar, depending upon how well it heals.

 

Mid-Forehead:

The incisions are made in a forehead crease, one on each side. Some surgeons choose to do this in male patients with baldness and deep forehead creases.

 

Temporal Lifts:

These are a little different from the other described techniques. Instead of lifting the entire brow, in a temporal lift the surgeon only elevates the outer half of the eyebrows. This can therefore be done with less surgery and fewer incisions. Typically the incisions are placed either in the temple, or at the hairline of the forehead. These can be performed under local anesthesia, without a general anesthetic, if preferred.

 

Recovery

The operation usually takes about one hour to perform, after which the patient goes to the recovery room prior to being sent home. A wrap is placed around the head, like a head band. Sutures are removed about a week later. There is some discomfort that is managed with pain medication.

 

Summary

The browlift is a procedure that can produce dramatic improvements in ones appearance. A more youthful, rested, attractive look is the goal. In experienced and skilled hands, this can be routinely achieved.

 

References

  1. Endoscopic subperiosteal browlift and facelift. Ramirez A, Clinics in Plastic Surgery. 1995

  2. In favor of the subcutaneous forehead lift. Ullman Y, Levy Y. Aesthetic Plast Surgery 1998

  3. Limited incision non endoscopic forehead lift. Tabatabai, N; Spinelli HM. Plastic and Reconstructive surgery. 2007.