Brow Lift (forehead lift)

Facial beauty is the result of a harmonious relationship between the different elements. With age, facial features sag in relationship to the underlying bone and cartilage framework. Frown lines deepen with stress and over activity of the muscles of facial animation. Trauma and nerve injury can also cause facial features to droop. A brow lit (forehead lift) helps reverse the trend of gravity replacing the facial features of the upper third of the face into their more youthful positions. The face regains a fresher less tired look. This operation can be done alone or in conjunction with other operations.

Forehead muscle hyperactivity over time can cause three problems:

• horizontal lines
• glabellar lines (forehead region between the eyebrows)
• brow ptosis (drooping of brow)

Muscles that animate the forehead can deepen overlying skin folds. The frontalis muscles lift the eyebrows and result in horizontal (transverse) lines of the forehead). Vertical lines in the forehead region between the eyes (glabellar region) are from the corrugator muscles. Horizontal wrinkles in this region are from the procerus muscles. The corrugator and procerus muscles depress and move the eyebrows together.

Who is a candidate for brow lift surgery?

Someone who has

• low or sagging eyebrows that may result in a tired or sad appearance.
• eyebrows low enough to cause redundant tissue of the upper eyelids (this hooding of eyelid skin can sometimes interfere with raising the upper eyelids.
• deep horizontal creases in the forehead.
• frown lines or vertical furrows between the eyebrows or across the top of the nose which may make you look angry and upset.

Preop	7 months after surgery

Brow lift surgery can help all of these problems. Any one or a combination of these problems can mean that brow lift surgery should be considered. It sometimes is done in conjunction with facelift surgery (rhytidectomy) and or eyelid surgery (blepharoplasty). Those who are bald, have a receding hairline, or prior upper eyelid surgery may still be good candidates. Surgical options depend on scars and other factors. Remember, a brow lift can enhance your appearance and self confidence. It is surgical sculpture and has its limitations. The surgery will not cause people to treat you differently. If you have unrealistic expectations, you will not be happy.

To see what a forehead lift may offer, stand in front of a mirror. Place your hands on the outer edges of the eyes above the brows. Gently pull the skin up to raise the eye brows and forehead. This is a rough approximation of what a brow lift has to offer.

Eyebrows and eyelids
Some patients come to our office concerned with the extra skin of their upper eyelid not realizing that their brows are low. Drooping brows can leave redundant skin for the upper eyelids to move out of the way to see. The extra skin can be as little as a slight fold, or so extensive to rest against the eyelashes. With the extra work, the lids can sometimes compensate only so well. Later in the day fatigue and excessive exertion make it harder and harder to keep the eyelids open. Dr. Bermant has seen some patients come into his office with their upper eyelid skin taped to their forehead just to see!

Preop	7 months after surgery

Dr. Bermant's Consultation
You should come to the office prepared for an extensive consultation. Dr. Bermant will need to learn about your medical history, problems, surgery and current medications. Prior cosmetic, facial, and eyelid surgery are important to tell me about. You will need to help him understand what bothers you. Brow lift surgery needs to be individualized to the patient. Forehead ptosis is a dynamic problem. He then needs to see how your face moves and the elements interact. After examining your facial features, he will discuss what surgery has to offer you. There are several different surgeries possible depending on the anatomical defect and the nature of your tissues. He then recommend what method of surgical sculpting is best suited for your problem and then discuss the risks, benefits and alternate methods of care. Understanding the benefits and limitations of surgery helps with realistic expectations.

Facial features important in surgical decisions with forehead lift.

• position of eyebrows
• amount of upper eyelid skin
• position of hairline
• male pattern of baldness
• degree of furrows
• nature of the skin

All surgery carries some uncertainty and risks
Complications are rare and usually minor in brow lift surgery.

The nerves that control eyebrow motion can be rarely injured on one or both sides resulting in inability to wrinkle the forehead or rise the eyebrows. Although usually temporary the loss may last for months or be permanent.

Broad unsightly scars are rare. Surgical revision may improve such scars. Hair loss may occur in some patients near the scar.

Lost sensation along or below the incision line is common but usually only temporary. The classic coronal brow lift has a greater chance for such loss with its longer incision. Sensation loss can be permanent.

The Surgery
Coronal brow lift
An incision is made starting just above the ears and continuing across the top of the scalp. Designed to be inconspicuous, it is usually hidden in the hairline. A small band of hair is removed to permit me to operate. Most of this trimmed region is removed with the operation. Keeping your hair long enough permits a style to camouflage this site until your hair grows back.

Hairline brow lift
When there is a high forehead, pulling the hairline back further can look strange. Dr. Bermant can sometimes place the incision just in front of the hairline in such cases to avoid adding even more height to the forehead. The scar at the hairline is designed to be inconspicuous. . However sometimes it shows and combing the hair over the forehead helps hide the scar. Men's hair styles and baldness may require special planning.

Bald heads do not have the forehead height problems. Thin scalp skin can heal very nicely and Dr. Bermant tries to hide the scars in a boney contour. Endoscopy and other methods help limit the scars.

Hair is organized with rubber bands.

This operation is usually performed as an out patient. This means you will go home after surgery. We attach a number of monitors to watch your pulse, blood pressure, heart, and blood oxygen level. Anesthesia is usually a combination of local anesthetics and sedation. In some cases Dr. Bermant will recommend general anesthesia.

After surgery you are taken to a recovery room to be closely monitored before discharge.

You will be wearing a dressing or headband to apply GENTLE pressure to the flap and protect the tissue. In some cases a small temporary drain (rubber tube) keeps fluid from cumulating. Our nurses will show you how to monitor and care for this drain.

Other Facelift pages:

• What makes a face look older?
• Facelift patient

About Dr. Bermant

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Facelift / Neck lift (rhytidectomy)

• Facelift 1
• Facelift 2
• Facelift 3
• Browlift
• Blepharoplasty
• Blepharoplasty 2
• Blepharoplasty 3
• Blepharoplasty 4
• Ptosis (drooping of upper eyelid)

Facelift

• What makes a face look older?
• Your consultation
• The Surgery
• After the Surgery
• Facelift patient 1
• Facelift patient 2
• Facelift and blepharoplasty patient before and after photographs
• SMAS Face lift surgical details
• Neck Lift surgical details
• Find books about face lift from Barnes and Noble
• Find books about basic plastic surgery from Barnes and Noble
  
• Browlift for eyelid ptosis

Liposuction the surgery

• part 1
• Liposuction consultation
• Tumescent Technique

Introduction to Blepharoplasty eyelid surgery

• Who will benefit from this operation?
• Risks and possible complications
• Planning your operation with Dr. Bermant
• Photographic details of the operation (some graphic images).
  • Lower eyelid blepharoplasty
  • Canthoplasty lower lid tightening
• Care after eyelid surgery
• Standard images for eyelid surgery and our preliminary evaluation package.
• Frequently asked questions about Blepharoplasty

Ptosis of the eyelid (drooping of the upper eyelid)

• Ptosis classification
• Ptosis associated with paralyzed eyebrow muscle
• Ptosis associated with Blepharophimosis (congenital eyelid deformity)

Ectropion (Drooping of the lower eyelid)

• Ectropion associated with Basal Cell Cancer

Recurrent ectropion after multiple cancer resections and then skin cancer excision with Mohs' chemosurgery and full thickness skin grafts.

Eyelid Reconstruction

• Lower eyelid reconstruction
• More lower eyelid Reconstruction
• Mustarde reconstruction for 70% eyelid defect
• Eyebrow cancer and reconstruction
• After camel bite

Learn more about Rhinoplasty surgical sculpture of the nose:

PlasticWeb

• Eye protection on the web

PlasticArt

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This page last updated on: January 1, 2010