Our facial expressions are influenced heavily by the appearance around our eyes. Our eyebrows convey many emotions, frowning, surprise, happiness and sadness. The shape of the female brow frames the eye. Its form has been sculpted since time began from Indian threading 6000 years ago, to the pharaohs of ancient Egypt defining the brow with Kohl, Heian girls of the Japanese imperial court removing the brow and redrawing it significantly higher up the forehead to 17th century European society elite who donned mouse hide brow wigs! Fashion and trends change but in general, when the shape of the eyebrow arches in its outer part, it is aesthetically pleasing. Conversely a low lateral eyebrow position indicates sadness or tiredness. A heavy middle brow indicates anger or distress. Similarly to eyelids, premature aging of the brow is in part hereditary, but very simple to correct.
The initial consultation is an opportunity for you to talk and me to listen. I like to understand what has led to my patients seeking advice on improving their appearance. During the consultation process, the most important thing for us to understand is the relationship between your eyebrow, upper eyelid and upper border of the eye socket. This helps identify if the eyebrow is genuinely low or if correction of the upper eyelid is needed. Sometimes it is both.
I could talk for hours (and have done!) on the aesthetics of the female brow. Trends and fashions change over time but in my experience a female brow that gently arches to sit 5-8mm above the lateral part of the bony eye socket is softer, feminine and aesthetically appealing.
In men however, this brow shape is feminising and unappealing. The brow should be flatter, less arched and sit in its outer third just on or very slightly above the bony rim.
There is very little variation between the sexes for the most appealing medial brow position. Sitting just on the orbital rim is ideal as long as heavy frown lines are addressed. Botulinum injections are a safe, quick and comparatively risk free method of achieving this.
During the consultation I carefully measure, document and photograph the brow and bony landmarks and can physically lift the brow by hand to assess the optimum position. This is something you can do in the mirror. if you lift the outer part of the eyebrow and excess upper eyelid skin remains, it may be that combination eyelid and brow surgery is necessary to achieve the best result.
Occasionally, I will suggest that surgical treatment may be premature and, if appropriate , suggest less invasive alternatives such as botulinum injections in the brow depressors muscles and/or filler in the lateral brow. I will ask you to show me historical photos so that we can really discuss what may be achievable, and only when you really understand the options available, their respective costs and associated downtime will we embark on a treatment path together.
This is a very simple procedure that is performed under local anaesthetic alone. It is my favoured technique as it produces an excellent lift whilst minimising bruising, swelling and downtime. It is also a limited dissection as it doesn’t release the medial brow. (which can be excellently treated with Botox® injections). A 2 cm incision is made behind the temple hairline and the forehead skin and muscle is elevated. It is then lifted into a better position and fixed either with stitches or a dissolvable ‘carpet gripper’ device called an Endotine®. The nerves to the frowning muscles of the medial brow can also be selectively cut which softens the middle brow.
Common in years gone by, the direct browlift involves removing a sliver of forehead skin in the hairline (tricophytic) or eyebrow line (wedge). The former is useful in those with high hairlines to reduce the height of the forehead and in older patients who have profound descent of the brows affecting visual field function.
The endobrow is the same procedure as the Lateral Temporal lift except it elevates the whole forehead (including the middle section) by using 5 separate incisions in the hairline. There is a risk of forehead numbness and headaches after this procedure and in my experience can lead to an overly elevated look. so I do not use this technique routinely. As described above the aesthetically ideal brow is not elevated in the midline.
This is a vital part of my surgical philosophy. When setting out my practice I wanted my patients to ENJOY their surgical experience. This is after all surgery they have chosen to have! I could have followed convention and operated out of leased theatres in large private hospitals but this didn’t fit with this philosophy. Overflowing car parks, receptionists I didn’t know, bank staff, theatre overruns and management dictat over patient experience. I travelled throughout Europe and the US to refine the model and my surgery is the result of this research. Custom built and registered facilities for facial cosmetic surgery, an environment that is a clinical home from home, staff hand picked not only for their expertise but their approach and interpersonal skills, and surgery that is natural, contemporary, safe and individually planned and performed by me for each and every patient from initial consultation through surgery to final follow up visit. I am constantly refining the model to give my patients the very best experience.
I believe that a patient that is relaxed, calm and comfortable, not starved for general anaesthetic, and who is familiar with the environment has lower blood pressure, lower circulating stress hormones and is in a far better place to start recovering from surgery.
My assistant Lucy discusses preoperative preparation with all my patients, and everything is considered. From hair colouring to diet sheets, pre operative medications, supplements and specifics to avoid such as blood thinners - Non steroid anti-inflammatories (Ibuprofen, Neurofen, Volatarol), Aspirin and Vitamin E.
Browlift surgery begins at the initial consultation. I want my patients to truly understand all the options available and the risks before undergoing surgery. I take written consent for the procedure(s) we have mutually agreed and give a copy to take away and read at leisure. Any queries that might arise are welcome to be clarified at a second preoperative consultation. On the day of surgery patients are escorted to the surgical suite where they are given their own temperature controlled warming gown and thick comfy socks.
After a relaxation tablet if desired, I use a tumescent anaesthetic solution to gently lift the forehead soft tissues and leave them temporarily completely numb. A small 2 cm is made behind the hairline which allows me to elevate the outer third of the brow. When the desired lift is achieved I fix the brow in its new position with stitches or an Endotine® prosthesis. A little over correction is perfect as the brow will settle downwards as the tumescent swelling subsides. I then use surgical staples in the hairline as these have been proven to improve the risks of hairloss at the incision site. The brow is than wrapped in a crepe bandage for 48 hours.
My patients literally walk out of the operating theatre into the recovery room and are back home (if local) or at the hotel within an hour accompanied by a family member or friend. It is quite normal to have some swelling but this subsides within 24 hours or so. Sleeping propped up on pillows helps take down the swelling. The hair can be washed immediately and the staples are removed at one week. Bruising varies and I have had patients return to work the next morning and others rest over a few days. Most are able to go out socially within a week.
Risks are minimised with adherence to pre and post operative guidance They are fortunately extremely rare with recent anaesthetic and surgical innovation and when they do they are usually a temporary inconvenience rather than a permanent problem. I do literally everything I can to minimise risks but when they occur I treat them with first class care and attention. The single biggest risk factor in facial cosmetic surgery is smoking. So much so, I do not operate on anyone who has smoked for 2 weeks before surgery.
This is quite common after browlift and transient. It is caused by stretching of the nerves of the scalp but easily treated with paracetamol
Bruising can happen, not so much in the forehead but around the eye where the eyebrow has been released from its deeper attachments. Soothing cold packs take the swelling and bruising down. Haematomas a very rare.
This is more of a risk with the full endoscopic browlift and due to stretching of the main sensory nerve of the forehead. Numbness over the lateral thrid of the eyebrow can happen and usually settles within a few weeks.