At a glance
Low brow position, eyelid hooding, beautification
Lateral temporal brow lift
Removal of Stitches
Return to work
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 ageing of the brow is in part hereditary, but very simple to correct.
The initial browlift 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. 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 browlift 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
Browlift surgery begins at the initial consultation. I want my patients to truly understand all the options available and the risks before undergoing any form of facial plastic 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.
Lateral browlift surgery 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. I use a tumescent anaesthetic solution to gently lift the forehead soft tissues and leave them temporarily completely numb. 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 with stitches. 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 24 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 10 days. 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 but might need camouflage make up if there is bruising.
In the days following browlift surgery, my team are in constant contact with my patients and review them regularly. This is an essential part of my practice and ensures that my patients feel confident, reassured and comfortable during their initial post operative recovery.
A mild headache is common and easily treated with paracetamol. Hair can be washed immediately and normal make up applied. As the brow is initially over elevated, it can take a few days to look more normal.
A lateral browlift reverses the descent of the lateral brow which descends due to absent counter pull from the forehead elevator muscles. The depressor muscles of the lateral eyebrow continue to pull the lateral brow down and it is wise to weaken this action with regular botulinum injections.
The brow, as with all soft tissue will continue to descend over the years but I have seen results last for 5 years or more.
Browlift Risks and Complications
No surgery is without risk, these risks are however minimised by careful patient selection, adherence to preoperative guidance and conscientious post operative care. The more common complications below are listed and the list is not meant to be exhaustive.
Where tissues are dissected there can be bleeding from small capillaries that create an expanding blood clot (haematoma), if treated promptly – this has no reflection on the final outcome other than prolonged bruising.
All incisions create wounds which heal to a very fine and barely visible scar in almost all patients. Some patients have a predisposition to poorer scarring which can be Raised (hypertrophic),Wider (keloid) or White (hypopigmented). Very rarely – I am yet to see it – there can be hair loss around the incision site which is usually temporary.
I prescribe prophylactic antibiotics routinely and It is not uncommon to need to use a topical antiseptic ointment on wounds to keep them clean
Weakness of the muscle that raises the brow might occur, usually due to stretching, swelling and tissue dissection. As no sharp dissection is used the risk of permanent nerve damage is very very small. If temporary weakness occurs it can last up to 12 weeks.
Less of a complication and more of an inevitability. As the skin is elevated it becomes numb in those areas for some weeks after surgery.
There is a possibility despite an excellent early lift, the opposing downward pull of the depressor muscles can lead to inadequate correction.
The definitive guide to anyone considering facelift and neck lift surgery. Essential research for potential patients.Read this first