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During a brow lift, the muscles under the skin in the middle of the forehead that cause grooves or frown lines between the eyes, increased heaviness of the eyebrows and horizontal lines across the forehead can be reduced or released to help create a smoother brow. Sagging eyebrows are usually first noticed in people who are in their forties, and this may be the time when you first start to think about a forehead or a brow lift. Brow lifts can be performed under a general anaesthetic, but for this procedure, many surgeons use a local anaesthetic along with a sedative to make you drowsy, so that you remain awake but feel very little discomfort. Although there are different brow lift techniques, the two main options that are used are the original open technique and an endoscopic brow lift. Most people return to work after 7 to 10 days this can often be sooner if you have had an endoscopic brow lift. Private costs for brow lifts can range from approximately £3,000 to £4,000.
Sun, wind, age, and the downwards pull of gravity all affect the face, often causing frown lines, wrinkling across the forehead, and an increasing heaviness of the eyebrows as the skin loses its elasticity. Sagging eyebrows are usually first noticed in people who are in their forties, and this may be the time when you first start to think about a forehead or a brow lift. During this treatment, the muscles under the skin in the middle of the forehead that cause grooves or frown lines between the eyes, and horizontal lines across the forehead can be reduced or released to help create a smoother brow.
One way of seeing what a forehead lift can do for your face, is to put your hands above your eyebrows and outside the edges of your eyes and gently raise the skin upwards. As well as raising the brows, it can also reduce the appearance of heavy or loose skin above the eyelids. However, if you are most concerned about the area above the eyelid, then eyelid surgery, rather than a forehead lift, may produce a more dramatic result for you.
Brow lifts are sometimes performed at the same time as facelifts, which help to reduce saggy skin around the jaw or jowls and loose skin in the neck area. These procedures are sometimes recommended for those who are showing premature signs of ageing or to reduce the appearance of looking very “tired”!
According to statistics from the American Society for Aesthetic Plastic Surgery (ASAPS), 21,868 Americans had brow (forehead) lift surgery in 2018, this is a decrease of 3.7% on 2017 and a decrease of 11.1% compared to 2014 figures. With the rise in non-surgical options using botulinum toxin, this could account for the fall in surgical brow lifts. No similar statistics are available for the United Kingdom yet, but each year, more and more people in this country are having forehead lifts.
Nowadays, this operation can be performed with less scarring and a quicker recovery using a procedure known as an endoscopic forehead or brow lift. An endoscope is a small tube with a camera at the end of it which can be inserted under the skin and then the surgeon can see the area requiring treatment on a screen.
If you're considering a brow lift, the following information will give you a basic understanding of the procedure. It can't answer all your questions, since a lot depends on the individual patient and the surgeon.
Please ask your surgeon about anything you don't understand.
Your first discussion with a surgeon should clearly set out how you want to look after this treatment and whether this result is possible for you.
Detailed discussions regarding the reasons for wanting a brow lift and your suitability for this type of surgery are very important at this stage. You surgeon should also discuss the differences between the two types of surgical technique used – endoscopic or the open (sometimes known as coronal) browlift. The differences between these are discussed below.
Make sure that you obtain as much information as necessary to enable you to make a fully informed choice about which you feel confident and happy.
It may be that a brow lift is not the most suitable procedure for you, or that you may need further additional procedures to achieve the results that you desire. Such extra procedures may include eyelid surgery, for example.
Your surgeon should also take a medical history, to ensure that there are no reasons why you shouldn’t have this operation. You would also normally be asked to sign a consent form at this time, which means that you have understood the potential benefits and risks associated with a brow lift.
Photographs will most likely be taken by the practitioner for a “before and after” comparison later. Importantly, this will also point out any oddities in your face such as differently shaped eyebrows or that one eye is lower than the other. Most people do not have identical eyebrow positions and shapes, and the surgeon will want to stress any obvious differences before you undergo an operation.
The surgeon may also wish to write to your GP giving details of the operation so that if there are any problems associated with surgery in the short or long-term, your doctor is aware of the procedure and can help you with the recovery.
Brow lifts can be performed under a general anaesthetic, but for this procedure, many surgeons use a local anaesthetic along with a sedative to make you drowsy, so that you remain awake but feel very little discomfort.
Please take into account that a general anaesthetic carries some potential risks; this should be clearly explained to you by the surgeon.
If you make a decision to go ahead with a brow lift, the actual procedure may take place in an outpatient surgical clinic, or in a hospital where you can recover overnight. The entire operation should take between 1 and 2 hours.
Although there are different brow lift operations, the two main options that are used are the original open technique and an endoscopic brow lift. The most suitable procedure for you depends on the structure of your face, the condition of your skin, and your hairline, in order to decide where the surgeon’s incisions should be made.
Your head does not need to be shaved for this procedure. Usually, an incision in the forehead running from ear to ear may be placed either on or slightly behind the natural hairline. An incision on the natural hairline generally heals more easily and has the advantage of lowering the hairline. The disadvantage could be noticeable scarring. Another option is to place the incision within the creases in the middle of the forehead. This is normally used in men with deep forehead lines, especially if they have a higher hairline owing to baldness.
After the cut is made, the skin of the forehead is lifted away from the tissues of the face so that it can be removed and the muscles of the forehead can be reduced or released. The eyebrows may also be raised and excess skin trimmed away. The cut is then closed with stitches or clips. Some surgeons do not use any dressings, while others choose to cover the wound with gauze padding and wrap the head in an elastic bandage.
In an endoscopic brow lift, rather than making one long incision across the top of the forehead, your surgeon will make between three and five scalp incisions of less than an inch in length in the forehead. An endoscope, which is a small tube with a camera on the end connected to a monitor, is inserted through one of the incisions allowing the surgeon to have a clear view of the tissues beneath the skin. Muscles and underlying tissues are removed or slackened and the eyebrows may also be lifted and secured into their higher position by stitches beneath the surface of the skin or by temporary screws placed behind the hairline. Finally, the incisions are closed with stitches or clips and, depending on your surgeon’s individual preference, gauze and dressings may also be used.
Depending on the procedure, you may be allowed to go home after a few hours, or stay in hospital overnight.
Most patients return to work after 7 to 10 days – this can often be sooner if you have had an endoscopic procedure.
Side Effects and Risks
There is pain and discomfort for several days following surgery. Facial swelling is usually at its greatest 24 to 48 hours after surgery, and it may take several weeks before all puffiness has disappeared.
Most bruising will disappear within two weeks. You will also experience some numbness in the facial area, which may be present for several weeks or longer.
As with any operation, there are risks or side effects associated with a brow lift or endoscopic browlift, such as reactions to anaesthetic, bleeding, haematoma, asymmetry (i.e. eyes or eyebrows not being perfectly symmetrical with each other) and nerve damage. Haematomas are collections of blood under the skin and, if small, can be absorbed back into the skin naturally over several days. Drainage may be required for larger haematomas.
There is also a chance that you might suffer headaches if your stitches are rather tight but this is only a temporary discomfort.
Injury to the nerves that control facial muscles is usually only temporary, lasting a few weeks to a few months, but can sometimes result in permanent numbness to some areas of the face.
There is a remote possibility that the nerves that control eyebrow movement may be damaged on one or both sides, which results in an inability to raise the eyebrows or wrinkle the forehead. Additional surgery may be required to correct this problem.
Infections after the operation, although rare, can occur.
Some hair loss may occur around the original incisions. Occasionally this can be permanent; usually it is not.
Operation scars are permanent, but they fade over time and are usually hardly noticeable, as they are often hidden either by your hair or the natural creases in your skin. Occasionally, however, scar tissue may widen and become thicker in the healing phase making it more noticeable.
It is very important that you carefully follow the advice of your surgeon following a browlift.
Post-surgery advice may include:
There are few reasons why you should not undergo a brow lift as long as you are in good general health and have realistic expectations of this operation.
Patients who have any problems associated with healing of their skin, or who have a history of keloid (raised, red, angry) scars are, however, generally poor candidates for this kind of cosmetic surgery.
As a result, your surgeon may not recommend this procedure or may caution you that scars could be raised and very visible.
Who Can Do It
Only fully trained and qualified surgeons should perform a brow lift or endoscopic browlift procedure.
For more information about practitioner training, qualifications and relevant medical organisations please view the information contained within the Legislation section of the Consulting Room.
It is unlikely that anyone considering brow lift or endoscopic browlift surgery would be able to access this free of charge on the National Health Service.
However certain regions do make special cases, and we would always recommend that you visit your General Practitioner before embarking upon a cosmetic procedure involving surgery. As well as their advice and guidance they may also be able to refer you to a local NHS Hospital who can treat you.
The NHS has set out the following guidelines on how to get cosmetic surgery through the NHS:
"To qualify for surgery on the NHS you must meet specific criteria as set out by your local health authority. The NHS will not pay for surgery for cosmetic reasons alone. Reconstructive and cosmetic surgery to correct, or improve, congenital abnormalities and injuries will usually be carried out free of charge.
NHS reconstructive surgery is performed by plastic surgeons who have had extensive training and belong to the British Association of Plastic Reconstructive and Aesthetic Surgeons. Surgeons who carry out cosmetic surgery through the NHS also belong to the British Association of Aesthetic Plastic Surgeons.
To receive cosmetic surgery from the NHS, you will normally need a referral from your GP. You will have a consultation with a plastic surgeon and an assessment by a psychiatrist, or psychologist. It will then be decided whether there is enough social, psychological, or physical benefit to be gained to justify surgery."
Private prices for a brow lift procedure can be in the £3,000 to £4,000 range.
Newer approaches, such as endoscopic surgery can reduce recovery time and scars following a brow lift.
A brow lift can produce very pleasing results by reducing forehead creases, raising eyebrows and reducing hooding over the eyes in an area of the face that can show early signs of ageing for some people. In short, you should have a refreshed, open-eyed expression to your face after this treatment which will make you look younger. These results can last for between 5 and 10 years.
If your main concern is loose upper eyelid skin, alternative or additional eyelid surgery may also be recommended.
It is important to note, however, that the surface of the skin is not changed by a forehead lift. Although the skin may be tightened, scars, age spots, fine lines and creases will soon return to their original state, and other procedures may need to be considered such as botulinum toxin (Botox®) injections or chemical peels if you want the surface of your skin to be improved.
Before and After Pictures
Results vary enormously depending upon both the patient and the skill of the individual surgeon, so outcomes for cosmetic surgery procedures will always be more variable than those for less invasive non-surgical treatments.
We currently do not have any before and after images for brow or forehead lift.