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Brow Lift

Introduction

What is a brow lift?

Sagging of the eyebrows is a common cause of baggy upper lids and is often wrongly treated with lid surgery (blepharoplasty).  Some patients think they need eyelid surgery when they actually have a drooping brow.  This surgery does not address the eyebrow problem and often leads to a less than satisfactory result. The brows are best lifted by keyhole (endoscopic) surgery with incisions made behind the hairline. Dr Lamb uses a CO2 laser in all these procedures to minimise bleeding, swelling and bruising to produce a faster recovery and better result.

Thread lifting and a nonsurgical lift usually performed by cosmetic doctors, has been shown to be of only temporary value and lasts approximately 12 – 18 months. A surgical brow lift should last at least five to ten years.

Is a brow lift for you?

To see what a brow lift can do for you, put two fingers above the outer part of your brows and gently lift the skin upwards and outwards. Dr Lamb will give you an accurate demonstration during a consultation.

Indications

The effects of ageing are inevitable and the brow and forehead area, as well as the eyes, often show the first signs. Sun, muscle activity, smoking and gravity all affect the face, resulting in loss of skin elasticity, frown lines, wrinkling across the forehead and increasing heaviness of the eyebrows.

Procedure

An incision of two to three centimetres is made behind the hairline on both sides in the temple region. The brow area is gently elevated to a natural, attractive position where the tail, rather than the head, of the brow is elevated. This prevents the ‘startled’ look that people fear most.

This is secured in position with ‘barbed’ absorbable sutures that can be adjusted in the post-operative period and will eventually completely disappear. Dr Lamb’s use of barbed sutures as part of the surgical procedure prevents any chance of over-correction. (This suture should not be confused with a commonly-used ‘thread lift’ or ‘stitch lift’ that only lasts 12 to 18 months.)

An Endotine fixation device is used to anchor the brow in its new position.  This also dissolves.

Dr Lamb uses an endoscopic technique with CO2 laser resulting in minimal incisions and less scarring, bruising and swelling.

Postoperative Instructions

No bending, lifting heavy objects or any strenuous exercises for ten days.  When lying down, use two to three pillows.  During the day, it is best to keep moderately active.  Lying down during the day will increase the swelling.

NO Aspirin products.

You may take Paracetamol tablets if necessary.

A small amount of blood ooze is normal during the 24 hours following surgery. 

Use antibiotic ointment on staples four times per day until staples are removed.  Take oral antibiotics 4 times per day until course completed.  Bandage can be removed if uncomfortable once home, otherwise morning after surgery.  Hair can be washed morning after surgery taking care around the staples.  The temple incision is closed with staples that are removed at three weeks with minimal scarring.

Risks

  • Haemorrhage and infection are remote possibilities and are made less likely by using smaller incisions and laser. Antibiotics are taken for five days post-operatively further reducing the risk of infection.
  • Swelling and bruising may occur but are usually minimal and temporary
  • Hair loss and scarring can occur at the incision sites and is unlikely.
  • Transient sensory changes usually occur at the incisions.
  • Nerve damage can occur and can produce numbness usually short term in the forehead region.  Nerve damage in the temporal region can cause weakness of the facial muscles with the potential for sagging of the face on one side.  This is again usually transient and is unlikely to occur, an endoscope is used for this procedure to identify important structures so as damage does not occur.
  • If the brow is elevated too much this can produce a startled expression, however this can be remedied in the early post-operative period.  If the brow elevation is not enough or asymmetrical the appearance may not be as good as desired and can also be corrected by adjustment or sometimes further surgery.
  • This procedure does not guarantee that the brow will not drop again over time.
  • The Endotine fixation device is not yet approved by Therapeutic Goods Administration.
  • Excess upper lid skin can persist after surgery.  The amount is unpredictable and may require excision to optimise results.

Treatment Alternatives

Direct brow lift involves an incision above the brow.  It is very effective but a scar can result.  Botulin toxin and skin filler can sometimes produce a slight improvement in brow position however it is temporary.  Threads or stitch lift involves only sutures and is not long lasting.

Combining a brow lift with other procedures

A brow lift is often combined with lower lid cosmetic blepharoplasty and canthoplasty.