As our skin ages, it loses elasticity, resulting in frown lines, wrinkling across the forehead, and an increasing heaviness that pulls the eyebrows down. Forehead lifts are an option if you have a sagging brow or deep furrows between the eyes. A forehead or brow lift tightens loose skin and, in some cases, removes excess skin, and forehead wrinkling and drooping brows can be modified. When necessary, part of the muscle that causes vertical frown lines between the brows is also removed.
The most popular treatment for the brow area today are botulinum toxin (BOTOX® Cosmetic or Dysport®) injections that can slow down the formation of wrinkles. Dermal fillers are sometimes used in conjunction with botulinum toxin to plump out the creases that form between the eyebrows as well as to lift the brow area.
Forehead and brow lift techniques
The endoscopic brow lift is most commonly done today. For a coronal brow lift or open brow lift, an incision is made slightly behind the natural hairline, running from ear to ear across the top of the head, in the same place that a headset would sit. The incision is usually made well behind the hairline so that the scar is not visible. If your hairline is high or receding, the incision may be placed just at the hairline, so as not to move the forehead back. Bangs over your forehead will usually conceal the scars sufficiently. Open brow or forehead lift procedures are less commonly performed with the advent of widespread use of botulinum toxin. The endoscopic forehead lift typically requires the same preparation as the coronal brow lift procedure but offers the advantages of minimal incisions within the scalp and a potentially shorter recovery period.
Open brow lift
Most forehead lifts are performed under twilight or general anesthesia. Your hair is tied back with rubber bands on either side of your head where the incision will be made. The head does not need to be shaved. After the incision is made, the skin of the forehead is lifted away from the underlying tissue so that it can be removed and the muscles of the forehead can be released. The eyebrows may also be elevated, and excess skin is trimmed away. The incision is then closed with stitches or surgical staples.
Endoscopic brow lift
Endoscopic brow lifts involve only three to five one-inch incisions in your scalp. An endoscope, a small wand with a camera on the end connected to a monitor, is inserted to allow the surgeon to have a clear view of the muscles and tissues beneath the skin. Another instrument is then inserted through a different incision, the forehead skin is lifted, and the muscles and underlying tissues are removed or released. Your eyebrows may also be lifted and secured into a higher position. The incisions are closed with stitches or staples.
The brow pexy is a method to redesign the position of the brows and make your eyes look less crowded, larger, and more open. Two to four small incisions are made in each eyebrow and hidden permanent sutures are placed to produce the lift needed.
Brow lift basics
- Time: 1-2 hours
- Cost: $3,500-$8,000, plus hospital or surgery center and anesthesia
- Back to work: 7-10 days
- Recovery: You will be instructed to keep your head elevated and apply cold compresses to reduce swelling. Stitches or staples are removed within a week, and the temporary fixation screws or other materials are taken out within two weeks. You will be able to shower and shampoo your hair within the first few days. You may have some numbness and temporary pulling around the incision. Swelling and bruising may also affect the cheeks and eyes but should begin to disappear in a week or so. As the nerves heal, the scalp may begin to itch, which may continue for several months. Some of the hair around the incision may thin, but normal hair growth usually resumes within a few weeks to months. Plan on resting for at least the first week after surgery and avoiding rigorous physical activity.
- Risks and side effects: There is a possibility that the nerves that control brow movement may be injured on one or both sides, which may result in an inability to raise the eyebrows or wrinkle the forehead. This is usually a temporary condition, but it may be long term or permanent in rare cases. Another potential complication is the formation of widened scars, which may require another surgical procedure to create a thinner scar or other scar reduction methods. The loss of sensation along or just beyond the incision line is more common with the open or coronal brow lift. Numbness is usually temporary and will go away in several months.
Wendy Lewis is a nationally recognized aesthetics consultant and the author of the Vibrant Nation Health and Beauty Guide, Cosmetic Procedures and Plastic Surgery After 50: Expert Advice for Choosing the Best Option for You.