The forehead lift, or brow lift, is one of my favorite procedures. It restores youthfulness to the upper face, which is very difficult for observers to identify. It creates subtle elegance. The elevation of the forehead improves the upper eyelid skin in a significant way. They are both very connected and one affects the other. The procedure corrects drooping brows and improves the horizontal lines and furrows that can make a person appear angry, sad or tired.
Dr. Delgado is focused on creating natural looking results. Entrusting your face to a surgeon is always a bit scary, but our practice has been working for nearly three decades to build a reputation in California and the San Francisco Bay Area. We recognize that you have many options when selecting a plastic surgeon. Whether you come for a brow lift, or any other procedure, we will do whatever it takes to ensure that you are well educated and cared for. We see patients from all over California, and take seriously the responsibility we have for patient satisfaction and well-being.
|Procedure||What it does||Surgery||Recovery||Results|
|Browlift and Forehead Lift||Elevates the forehead and brow area||Yes||10-14 days||10-15 years*|
|Botox||Temporarily smooths out brow wrinkles and forehead lines||No||None||Up to 6 months*|
*Results may vary.
In recent years, the surgical approach to the eyebrow region has been advanced with the use of the endoscope. The endoscope is a specially designed instrument with a camera that passes through a very small incision, which allows the endoscopic image to be shown on a TV monitor. The advantage of endoscopy is the noninvasive nature of the technique. We are now able to achieve equal results with the endoscopic techniques that we were able to achieve with the “open coronal” approach. In the coronal approach, an incision is hidden just behind the hairline and is made from ear to ear. With this approach, the problems have been scarring, hair loss, widened scars and the cutting of nerves that feed the top of the head.
However, the coronal brow lift is the gold standard. The results that this technique achieves are long lasting and effective. The endoscopic approach largely avoids some of the problems that are disadvantageous by the open technique. In some cases, when the forehead is unusually high, one may need to use a coronal approach to avoid elevating the forehead further. This involves an incision just at the hairline.
The forehead lift is most commonly performed in the mid 40 to mid 60 year age range. Many people first notice a tired appearance in the region around the eyes as they approach their early 40’s. Others may notice the development of furrows or frown lines through stress or muscular activity. This may give the appearance of sadness, depression, unhappiness, or even anger. With the passage of time and the influence of gravity, the eyebrows descend to a slightly lower position over the eyes. This “hooding” of the tissue around the eyes contributes to the tired appearance. In some men and women, the eyebrows are a different height naturally and with this technique, one can achieve a more symmetrical brow level.
The art of brow lift surgery is to assess what components around the eyebrows need to be altered. For women, the forehead and the in- between the brow creases are treated more aggressively than in men. The eyebrow position is higher in women than in men. It is very important not to feminize a males upper facial region.
All facial surgery requires that you rest and recuperate fully before you return to work. We have two convenient locations for surgical follow up in San Francisco and the Northern Bay Area. We treat every patient as an individual, and whether you live in Marin County, Sonoma County or anywhere in California, we will do whatever it takes to ensure that your treatment and recovery go as well as possible.
Before Brow Lift Surgery
At your first consultation, Dr. Delgado will ask you to discuss your concerns about your appearance. At this time, he may utilize computer imaging to point out concerns that you may have. Through this technique, he can modify your appearance to help you visualize the changes. Dr. Delgado will measure the distance between your mid-pupil to the top of the eyebrow to determine the degree of laxity. If you are a good candidate, Dr. Delgado will explain the best procedures that will achieve your goals.
Dr. Delgado will give you a precise preoperative instruction booklet that will explain your medications and any preparations that you need to make at your home. This preoperative booklet will also give a concise list of aspirin and aspirin-containing compounds, including anti-inflammatory products that must be stopped two weeks before and two weeks after surgery. However, Tylenol (acetaminophen) can be safely taken during this time. However, do not exceed 1 gram over 4 hours or 4 grams per day from all sources since this can cause liver damage. You will also be given a list of vitamins and homeopathic drugs to take prior to and after surgery.
Day of Brow Lift Surgery in San Francisco
The endoscopic brow lift is generally performed as an outpatient procedure. Often times, it is combined with a face or eyelid lift.
The vast majority of endoscopic brow lifts are done under general anesthesia. However, in some cases, one may use local anesthesia with IV sedation. Dr. Delgado and the anesthesiologist will assist in making the best decision for you.
Before anesthesia is given, the patient is marked for the incisions and the direction of the forehead vector pull. Two or four incisions are made behind the hairline, approximately 0.5 inch in length. The hair is not shaved, but only parted. The endoscope is placed within the incision and specialized instruments are used to make the forehead dissection. A TV monitor is used to observe the dissecting plane. The brow is released from the surrounding tissue and the muscles are divided around the frown lines, without compromising expression. The eyebrows are then pulled up and fixated into position. Dr. Delgado uses a new fixation device call Endotines by Microaire. The Endotine® device is implanted into the skull and provide reliable fixation throughout the post-operative healing period, and eventually resorb as biological fixation takes over. After engaging the tines the incisions are closed with small sutures and a light compression dressing may be placed. The key to a good endoscopic brow lift is a complete dissection, good fixation and, most importantly, not over-elevation to cause a “surprised” look.
Another brow lifting procedure that is more popular with men is called the brow-pexy. This technique is performed through the upper eyelid and lifts the outer brow. This can be fixed with a smaller endotine or a suture. The corrugator muscle that causes the frown lines between the eyebrows can also be resected through the upper eyelid. As you can see a significant amount of brow improvement can be performed through the upper eyelid.
If the more conventional coronal brow lift is performed, then the incision goes just inside the hairline. The only advantage of this technique is that it does not raise the forehead, but the disadvantage is the longer incision. This incision is rarely performed on men.
After Eyebrow Lift Surgery
The first few hours after surgery will be spent in the recovery room. When you are completely alert, you will be able to go home with someone to assist you. We advise icing or cold packs around the eyes for 48 hours to reduce the swelling and to sleep with the back and head elevated for approximately five to seven days. Some patients will spend the night in the after-care facility, especially if a facelift procedure is performed. The following morning, the facial band is removed to examine the operative site. You can shower, wash your hair with soap and water and reapply the band the following day. The sutures are removed in approximately seven to ten days.
There is minimal pain with the endoscopic brow lift. The patient describes swelling and a numb feeling to the forehead area, but discomfort is minimal. The numbness subsides as the swelling dissipates. Pain medication is prescribed, but used for a day or two. Sleeping with the head and back elevated is critically important in reducing the amount of swelling. The swelling and bruising usually subsides completely within ten to fourteen days. Most patients return to work and social activity after seven to ten days and strenuous exercise can be started in four to six weeks.
RISKS AND COMPLICATIONS
Risks and complications are rare and usually minor when a forehead lift is performed by a qualified plastic surgeon, yet the possibilities of complications must be considered. Like all surgeries, the risk of bleeding, infection, scarring or an anesthetic problem is possible. The risk from complications, however, from the endoscopic brow lift are less than would be with the standard coronal lift. For example, there is less scarring, potential hair loss and no significant degree of numbness. In rare cases, the nerves that control the eyebrow movements could be affected on one or both sides. If this occurs, it is usually temporary.
The results of the endoscopic brow lift surgery are a more-rested and revitalized upper portion of the face. This technique greatly reverses the angry, unhappy, sad or tired appearance. The improvement can be expected to last many years. However, you will continue to age and gravity will still occur, but the area will always look more rejuvenated. The brow lift techniques can be done again in time if necessary.
Frequently Asked Questions
What is a brow lift?
A brow lift is a surgical technique that elevates the entire forehead, eyebrows, and redundant skin around the crow’s feet areas. It also lifts the skin above the eyelids. This opens the upper eyelids in a beautiful way and eliminates any heaviness caused by a sagging brow. This popular procedure has a high rate of patient satisfaction.
How do I know it will make me appear more youthful?
Try this simple test: while looking in a mirror, use your fingertips to elevate one of your eyebrows. Look at the elevated brow compared to the non-elevated side. Also, note how the upper eyelid is improved.
What is the difference between an endoscopic brow lift and a coronal or open brow lift technique?
The coronal or open brow lift is the older technique. An incision is made from ear-to-ear and the procedure is performed with the skin pulled back and the forehead musculature completely exposed. This allows for a very complete elevation of the brow and forehead, and surgical relaxation of certain muscles that cause frown wrinkles. The negative aspect of this technique is the long incision along the hairline. Besides a fairly obvious scar, it may decrease the area of healthy, hair-growing scalp tissue and can also cause permanent numbness to the top of the head.
The evolution of endoscopic surgery revolutionized the brow lift technique. The goal has been to achieve the same results as with the open technique and this has been very nearly achieved. The advantages of the endoscopic technique are significant: no lengthy incisions resulting in unsightly scarring and minimal or no potential hair loss.
Which technique is better?
Dr. Delgado believes the endoscopic technique is superior when all aspects are considered. The endoscopic brow lift requires advanced equipment and specialized training. Dr. Delgado has been performing this technique since it was introduced about the mid-nineties. The open technique is still a good option for patients who want shortening of an overly tall forehead.
How long will it last?
A brow lift, achieved by either technique will last for 10-15 years. The open technique may last a little longer since scalp tissue is excised and the forehead is permanently shortened. No scalp tissue is excised in the endoscopic brow lift, but it is raised into a precise position and subcutaneously secured to the skull. Dr. Delgado uses the popular Endotine fixation system.
Can other procedures be done at the same time?
Yes, it is very common to do other facial procedures such as eyelid surgery, facelifts or nose reshaping at the same time. Even body procedures such as breast surgery, tummy tucks or body-contouring liposuction can be combined with an eyebrow lift.
I do not like the over-elevated or “surprised” look. How can this be prevented?
Dr. Delgado is committed to producing a natural look for his patients and considers it his signature. He prefers to under-correct rather than over-correct. His technique for eyebrow elevation and fixation involves precise measurements that he calculates prior to surgery. Before he begins the procedure, he transcribes these pre-determined landmarks onto the skin with a special surgical felt-tip marking pen. As surgery starts, these are translated onto the deep tissue. Dr. Delgado then elevates and fixes the tissue to perfectly match the pre-determined locations. These are very important steps as the injection fluid, used to aid in separation of the tissues, control pain, bleeding, and inflammation, also distorts the appearance of the eyebrows.
What is the cost of a brow lift or forehead lift?
The cost of a brow lift is between $6000 and $7000 dollars. This includes the surgeons and anesthesiologist’s fees, and use of the outpatient surgical facility at Marin Cosmetic Surgery Center in Marin County, California. This also includes all follow-up care.
When can I return to work and exercise?
The surgery produces swelling and may produce some bruising around the eyes. The swelling reduces quickly but the bruising persists for 10-14 days. Patients are able to drive after one week and can return to work after the second week. Exercise programs may be resumed after four to six weeks.
What can I expect after my brow lift?
Expect a subtle yet elegant revitalization of the upper face region. With an endoscopic brow lift, the small scalp incisions are well-hidden by hair. For patients who have an angry look due to a heavy or sagging brow, a brow lift brings a natural but dramatic transformation to his/her face with a refreshed and softened expression.