Brow/Forehead Lift

Eyebrow lift / Forehead lift

As we age, the eyebrows may become depressed and overlap the eyelids.  In general, women’s eyebrows arch above the bony ridge of the eye and men’s tend to lie right over the bony ridge.  It is very important to assess the brow position when evaluating for eyelid surgery, as droopy eyebrows can give one the false sense that the eyelids need lifting.

Forehead lifts are usually recommended when a patient complains of baggy upper eyelids and forehead wrinkles, low eyebrow position, and excessive upper eyelid and brow skin.  Also, those who have asymmetric brows and high hair lines are also candidates.

The goals of brow and forehead lifting are to improve eyebrow position, reduce the amount of excess skin in the upper eyelids, and to decrease the appearance of wrinkles between the brows and in the forehead.  Also, the muscles that cause scowling in the brow and forehead are treated to decrease their activity.

Surgical Techniques

Green line (A) - Trichophytic incision Yellow line (B) - Coronal incision Red lines (C) - Endoscopic incisions

Green line (A) – Trichophytic incision
Yellow line (B) – Coronal incision
Red lines (C) – Endoscopic incisions

There are several techniques for performing brow and forehead lifting.  There are open and endoscopic techniques.  The older technique involves a large scalp incision.  This technique is indicated for those that have a very low hairline and desire a lengthening of their forehead and therefore raising their hairline.  This technique can cause numbness of the scalp and hair loss in the incision line in some cases but not all.  More contemporary techniques include a mini open brow lift and endoscopic brow lift.

The mini open brow lift uses a smaller, trichophytic incision.  This incision is a beveled incision just inside of the hairline and will not raise the hairline.  In some cases, the hairline may be lowered.  The beveled incision is created so that the hair will grow through the scar to render the scar virtually undetectable.  The endoscopic brow lift is more conservative approach which uses several small vertical incisions inside the hairline.  The disadvantages of this technique are elevation of the hairline and the use of plates, screws or pins / tacks to suspend the brow.  These are placed by drilling small holes in the bone.  In some cases, the hardware requires removal.  Dr. David Mueller, a Virginia Beach facial cosmetic surgeon has extensive experience with brow and forehead lifts.

Brow lift techniques can be performed with local anesthesia, IV sedation and general anesthesia.  The procedure can also be combined with blepharoplasty and facelift / necklift procedures.

Non-surgical brow lift

For those that just do not want to have a surgical procedure, Dr. Mueller uses a combination of a neurotoxin (Botox or Dysport) and hyaluronic acid (Juvederm or Restylane) to create a mild elevation of the brow.  This procedure will not take the place of a surgical lift, but can give a mild lift when the patient elevates their brow.  This procedure should not be construed as a replacement for a surgical brow lift, but can give a refreshed look in about ten minutes for selected patients.