"Artistically, facial rejuvenation looks more natural if the upper and lower face are in harmony."
Some of the earliest signs of aging occur first in the upper part of the face. Shape and position of the brows are intimately associated with beauty and expression. As the tissues of the forehead relax, the eyebrow begins to descend, first at the outer portion of the eye, and later progressing to cover more of the upper eyelid, resulting in a sad or tired appearance. Surgery on the eyelids alone cannot satisfactorily rejuvenate the upper face.
Brow lift surgery, performed at our Minneapolis-St. Paul-area practice, is a procedure that elevates the brow to a more youthful position. It is frequently performed along with facelift and surgery on the eyelids for facial rejuvenation. The aesthetic goal of rejuvenation of the forehead is obtaining a youthful shape to the brow, not just elevation of the brow, which results in a '”surprised” look.
Dr. Szachowicz uses three approaches to brow lifting surgery: the TransBleph Direct Brow Lift, the Endoscopic Brow Lift, and the Bicoronal Brow Lift. Each procedure has three main goals:
- Elevate mostly the outer portion of the brow to gain the most youthful shape of the brow;
- Soften and weaken the strong frown muscles; and
- Have the least disturbance of the hairline.
TransBleph Direct Brow Lift
The TransBleph Direct Brow Lift is a newer approach to elevate the outer eyebrow at the same time as surgery on the upper eyelid. The incision in the upper eyelid is in the crease of the upper eyelid, the same as in usual surgery on the upper eyelid (blepharoplasty), and the procedure then includes a release of the eyebrow at the bony ridge above the eye. The eyebrow is elevated into the desired position and is then anchored in place to the brow-bone with a bio-absorbable fixation device called an endotine. With the eyebrow now in a more youthful position, and the hooding removed by elevating the outer portion of the eyebrow, only the true excess of skin on the upper eyelid is removed. The incision in the crease of the eyelid then closed normally using fine sutures.
A small implant holds the raised eyebrow in the desired position until healing is complete and is then absorbed naturally by the body. This procedure is warmly accepted by people who already feel that they have too much skin on the upper eyelid and want more complete rejuvenation near the eyes than is offered by just a routine blepharoplasty. Recovery is similar to that for surgery on the eyelids alone.
This procedure is an excellent option for those with a high forehead or thinning of the scalp hair, and is preferred by men who desire a more subtle lift to the brow.
Endoscopic Brow Lift
Of all approaches to surgery to lift the forehead, one of the most common is the endoscopic approach. Many people are familiar with other minimally invasive surgery now done through small incisions with the aid of tiny telescopes and instruments. Endoscopic surgery on the brow begins with only four small incisions hidden within the hairline. Using lighted telescopes, a monitor, and specially designed instruments, structures of the forehead and brow are released, starting from the hairline all the way down to the bony rim. The muscles responsible for frowning are then surgically weakened. Structures of the eyebrows and forehead are now ready to be elevated to create a height and shape to the brow that are more youthful, and to open the appearance of the entire region around the eyes.
To maintain the proper position of the brow during the healing process, the forehead is supported in an elevated position by an absorbable Endotine device. This device has the ability to hold the forehead and brows in position for up to three months as your body heals the brow back to the underlying bone in its new elevated form. The four small incisions are then closed within the hairline and become barely visible with healing.
The popularity of the endoscopic approach stems from the very natural results of the brow lift, the preservation of the shape and density of the hairline, and the minimal incisions in the scalp. The endoscopic brow lift is often the first procedure considered to correct the earliest signs of facial aging, and is frequently combined with blepharoplasty, or surgery on the upper eyelid. When combined with facelift surgery, the endoscopic brow lift brings a blended harmony to the overall facial rejuvenation, as the upper and lower facial units are re-draped together, giving the most natural appearance.
"Combining a brow lift with a facelift restores harmony and balance to the face; all the tissues are re-draped together."
The Bicoronal Brow Lift (Incision Either In the Hair or Along the Hairline)
The bicoronal approach to brow lifting is sometimes required when there are more severe age-related changes in the forehead, and if there are special considerations in the hairline such as a hairline that is already too high. The bicoronal incision begins just above the ears and extends to the top of the head, either hidden back into the scalp or along the front of the hairline, called pretrichial. The structures of the forehead are then released, followed by weakening of the frown muscles, and sometimes weakening of the muscle of the forehead if creases in the forehead are too strong. Excess skin and/or scalp is then removed, and the incision is closed. This approach gives the most enduring correction to relaxation of the forehead and brow.
Recovery & Aftercare
All brow lifts are performed as a procedure in a same-day surgical suite, using either sedation or general anesthesia. You return to the medical office the following day to have the dressing removed, and you may shower and shampoo thereafter. All sutures and clips are removed by 10 days, and any time thereafter you can cut, color, and style your hair as usual.
Most people return to regular activities within 7-10 days. BOTOX® Cosmetic or Dysport® given before the procedure will allow healing to occur without the downward pull of the facial muscles which can affect the overall outcome of healing. If an Endotine device is placed, this will dissolve naturally over the next three months. Numbness in the scalp is common, and usually diminishes over time. Dr. Szachowicz uses homeopathicarnica Montana pellets and gel to minimize swelling and bruising.
Risks of Brow Lift Surgery
Overall, risks are related to the type of brow lift selected, and are rare, especially when an endoscopic brow lift approach is used. With healing there is some itching in the scalp. Persistent itching or painful nerve injury are rare.
Learn More about Brow Lift Surgery
If you want more information about brow lift procedures, contact our Edina office to learn more and to schedule a computerized video-imaging session to simulate your result.