Brow lift, forehead lift, endoscopic lift- the full picture
Eye brow lift surgery is performed when the eye brow is droopy. The drooping cause an overhang of upper eyelid skin over the lashes, which can interfere with the superior vision. Eye brow and forehead droop can occur on one side or both sides.
The need for a forehead lift can develop with ageing changes to the face. Occasionally brow droop can develop due to damage of the nerves that supply the eye brow as in the condition of Facial palsy or injury.
Why is Eye Brow Lift surgery done
A browpexy is a surgical procedure that can be done in those with minimal brow droop and are undergoing a blepharoplasty at the same time. Mr Ahmad Aziz will advise you if this is needed when assessing you in the Central London clinic with an excellent surgical facility. It can be done with local anesthesia if down with eyelid surgery or eyelid lift.
Brow lift or forehead lift is the brow lift procedure done to lift more severely drooping brows back to their natural position and reduce the overhang of skin that interferes with the vision. It may also be done to try and improve the facial symmetry that is lost in one sided facial palsy or after injury and reduce the frown lines or horizontal lines that appear on the forehead when constantly raising the brows to see. It may also be done for cosmetic reasons if there is no blockage of vision to give a more youthful and less tired appearance and treat any aching in the eye brows as they strain to lift the eyelids without the need for eyelid surgery in some patients.
What re the risks?
Possible risks of forehead and brow lift surgery include:
Bleeding from the surgery
Dryness and irritation of the eyes
Difficulty closing the eyes
Scarring (although this is usually put into the eyelid skin crease to hide it as much as possible)
Drooping of the other eye if one eye is treated
A need for follow up surgery
Temporary blurring of the vision
Rarely, loss of vision
Risks associated with surgery more general including anaesthetic reactions and blood clots
To know which risks most apply to you talk to your doctor to understand more about the eye brow ptosis lift surgery as well as the benefits and if they apply to you. This way you can decide with your doctor if eye brow ptosis surgery is a good option.
How you prepare?
Before having a lift with eyebrow surgery to treat your eyebrows you will meet your Oculoplastic surgeon who specialises in eye brow lift surgery to consider whether lift surgery or a browpexy is required and to discuss:
Your medical history including any previous surgery and current eye conditions.
Your expectations with an honest discussion about what can be realistically achieved.
A vision examination to check the eyes prior to surgery.
A physical examination of the eyelids to ensure that this is the correct procedure.
Eyelid photography which can help with surgical planning and to provide evidence for any insurance claim.
It is preferable to stop taking any blood thinner medication such as aspirin, ibuprofen, warfarin, apixiban and any other medication that can cause increased bleeding during eye brow lift surgery. Your doctor will discuss these with you to ensure that it is safe for you to do so prior to your eye brow lift surgery and will tell you how long before the operation.
Stoping smoking several weeks before surgery can help improve the healing after eye brow lift surgery to lift the eye brows.
You should arrange for someone to take you home after the procedure and stay with you for the first night following the operation.
What you can expect before the surgery?
Lifting the eyebrows with eye brow surgery is usually done as a day case where you can go home the same day. Your surgeon will inject anaesthetic into your forehead to numb the area and you can also have medication through a drip to help you relax. Sometimes the surgery needs to be done with the patient asleep under general anaesthetic.
What you can expect during the procedure
There are three main approaches to lift the eye brows in eye brow ptosis surgery
1. Direct brow lift
A direct approach can be used with an incision placed within one of the horizontal forehead lines to hide the incision.
An area of forehead skin is removed from above the eye brow to lift the eye brow and the incision is sutured back together. Depending on where the incision is made this can leave a scar either just above the brow, in a forehead skin crease.
2. Trans-eyelid brow lift browpexy
If the patient also has excess upper eyelid skin that needs removing, the brow lift can be done through the same upper eyelid skin crease incision. Sutures are placed beneath the brow securing it higher up to the deeper tissues. This is useful if only a small amount of brow ptosis is present as it provides a small lift of the eye brows.
3. Endoscopic brow lift
an endoscopic procedure or endoscopic lift of the brow with small scars hidden within the hairline. This may also be known as an endoscopic forehead lift. Small incisions are made above the hairline in the scalp. A tunnel is made from the tiger incisions to the brow freeing it from the tissues holding the brow down. Sutures or fixation plates are then used to lift the eye brows. This surgery requires general anaesthesia with the patient being asleep.
A coronal brow lift is done with a scar also in the hairline lifting the forehead to raise the brow and removing any excess skin without an endoscopic technique. A temporal brow lift is a cosmetic procedure that can be used to raise the outer brow area in those who need just a partial lift to this area to a more youthful position. These are forms of cosmetic surgery to the forehead. The brow lift techniques vary and the type of browlift surgery used will depend on the appearance of the forehead wrinkles and facial features as well as the desired aesthetic goals. These would be assessed at the initial consultation.
It is best to choose an oculoplastic surgeon when deciding to undergo forehead lift surgery as they are very familiar with plastic surgery in this area of the face. A cosmetic surgeon, plastic surgeon or facial plastic surgeon may offer procedures in this facial area but it is important to ensure that they are specialised in this region.
What you can expect after the procedure
After surgery you are monitored for complications. You are able to leave later that day to recuperate and begin the healing process at home.
After surgery you may temporarily experience:
Blurred vision from the lubricating ointment applied to your eyes at the time of ptosis surgery
Watering of the eyes
Sensitivity to light
Puffy, numb eyelids from the anaesthetic and eye brow lift surgery
Swelling and bruising similar to having black eyes which will settle within a week
Pain or discomfort
Your doctor will likely suggest you take the following steps after surgery:
Use ice packs on your eyes every hour the night you go home after the operation. The following day, use ice packs on your eyes four to five times throughout the day to help reduce the swelling
Gently clean your eyelids and use prescribed medication.
Avoid straining, heavy lifting and swimming for a week after the eye brow lift.
Avoid strenuous activities, such as aerobics and jogging, for a week.
Avoid rubbing your eyes.
Not to use contact lenses for about four weeks after surgery.
Wear darkly tinted sunglasses to protect the skin of your eyelids from sun and wind.
Sleep with your head raised higher than your chest for 3 days after the surgery.
After a few days, return to the surgeon to have stitches removed, if needed.
Seek medical attention immediately if you experience any of the following:
Shortness of breath
An unusual heart rate
Severe new eye pain
What are the results?
The patients experience is usually positive with the results of eyebrow lift surgery and benefit from a more youthful appearance, better vision if the peripheral field was being obstructed and more self confidence. The results of the surgery can last a lifetime but for others the drooping may recur with time.
The bruising and swelling noticeably settle within 2 weeks resorting a more natural look giving you confidence in going out publicly and subtle swelling that the patient may notice will generally resolve over a period of 2 months in the majority of cases. The recovery time does have a degree of variation between one person and another. Normal activity can resume after 2 weeks.
Scars from the surgery can take months to fully fade but should be within the skin crease and well covered. You should protect your eyelids from too much sun exposure as you should do for the rest of your skin.