The position of the brow has a significant impact on the overall appearance of the face, and the emotion that it conveys. As we age, increased forehead and frown area wrinkles combined with a lowering of the position of the brow, can give a tired or cross look that is in conflict with how we actually feel. While botulinum toxin injections are very useful in this area, and can be administered in such a manner as to give a subtle brow lift, there are certain other issues that can only be addressed with surgery. One of these is brow ptosis, or droop. As the brow descends, it may cause hooding of the upper eyelid skin. It is not uncommon for someone to seek an upper eyelid surgery in this situation, when in fact it is a brow lift that is necessary. For this reason, it is very important that the face as a whole is assessed in planning this type of surgery. Indeed, it is not uncommon for a brow lift to be combined with other types of facial rejuvenation surgery such as a facelift, eyelid lift, or fat injections (lipofilling) either at the same sitting or as part of a series of treatments. A brow lift will effectively treat deep forehead wrinkles (static wrinkles), and further improvements in skin texture may be obtained through resurfacing procedures and skin care products.
Type of anaesthetic
Length of surgery
Nights in hospital
High in hairline on either side
1-2 weeks off work
4 weeks gentle exercise
6 weeks strenuous exercise
1 week (dressing clinic)
I will always assess the brow and eye area in the context of the face as a whole. While a brow lift alone may well give the desired result, it is always useful to consider how other treatments, across the spectrum from skin care, through non-surgical and minimally-invasive, through to surgical treatments, may be combined in order to achieve the best possible result. I will explain my thought process to you, and together we can reach a decision on the best approach for you taking into account your treatment goals, budget, and acceptable down-time.
A number of different surgical techniques for brow lifting exist. The technique employed depends on the existing level of the brow, desired amount of lift, the gender of the patient, and various other factors. Generally speaking, the brow can be approached from above or below, with more substantial changes achievable when it is approached from above. Traditionally, an open brow lift, involving a scar extending from one temple to the other, well behind the hairline, was used. This is still a good approach where a large degree of lift is necessary. In the majority of cases, however, a minimally invasive technique using a small incision high up in the hairline and miniscule scars within the brow itself, will give excellent results, and this is my technique of choice. A subtle lift may be achieved when the brow is approached via an upper blepharoplasty (eyelid lift) incision, often performed in combination with that procedure. This technique is particularly useful in male patients in whom a large degree of lift is undesirable (an over-arched brow will give a feminine look to the upper face). It also avoids scarring in the temple area, which may be or become obvious with very short hair or a receding hairline.
Consequences and limitations
Some bruising and swelling is normal following surgery. A bandage placed around the head at the end of the procedure helps to reduce the swelling somewhat, and is usually worn at least overnight following surgery. Sleeping in a relatively upright position can also help, and is recommended. Incisions within the hairline are closed with skin clips, which will be removed approximately a week later. I use clips rather than stitches as they cause less damage to the hair follicles, but even with this precaution, and the placement of the incision in such a manner as to minimise damage to the follicles, there is a risk of some temporary or permanent hair loss in the scar itself and the adjacent skin. The entire forehead is likely to feel numb immediately after the surgery, and there may also be some numbness behind the scars, further back on the head. This numbness is temporary in the majority of cases, however on occasion, some permanent numbness on one or both sides of the forehead can occur. Some patients will find that they are unable to move one or both brows following surgery. This is typically due to stretching of the frontal branch of the facial nerve, and usually recovers in the weeks to months following surgery. Any asymmetry as a result of this is well managed with botulinum toxin injections to the opposite side, which treat the discrepency in movement between the two sides. Traditionally, the frown area muscles were divided during a brow lift, reducing the movement in that area. With the minimally-invasive brow lift technique I employ, movement in this area is usually conserved, and can be managed with botulinum toxin injections if desired. The lift is achieved using strong stitches, and occasionally patients may feel the knot of these stitches within the hairline. Generally this is well-tolerated, however some people may experience minor irritation, or in a worst-case scenario, some extrusion of the suture material. A further small surgical procedure may be needed in this instance.
Like any procedure done on both sides of the face or body, there is a risk of asymmetry following a brow lift. Great care is taken to achieve a symmetrical result at the time of surgery, however, pre-existing differences between the sides, habitual facial expressions, the side on which you prefer to sleep, and a number of factors may effect the final position of the brow. The degree of lift achieved during surgery will never be completely maintained – for this reason, a degree of over-correction is necessary, and unless pre-warned, this can be concerning for patients. This will gradually settle in the weeks to months following surgery.