Frequently asked questions about brow lift surgery
What is brow lifting and what can it achieve?
What is an endoscopic brow lift (endobrow)?
What does a brow lift operation involve ?
How will I feel after brow lift surgery? How quickly will I recover?
Is brow lift surgery safe?
How long do the results of a brow lift last?
How do I arrange a consultation with Mr Hamilton in London regarding brow lift surgery?
What is brow lifting?
Whilst muscle relaxing injections such as Botox can reduce the appearance of lines and wrinkles on the forehead and around the top of the nose very successfully, in some people the brow has drooped such that the eyebrows sit lower than previously (usually on the edge of the bone above the eye for men and a little above it for women) and the upper lid can become “hooded” and heavy with the appearance of excess skin. Brow lifting is a procedure where the tissues of the forehead are lifted to a higher position, raising the eyebrows a little and usually opening out the upper eyelid to give a more youthful and rested appearance. At the same time, the muscles around the top of the nose can be weakened to reduce the appearance of lines and wrinkles in that area.
What is an endoscopic (keyhole) brow lift?
In the past, most patients undergoing this type of procedure would undergo an “open” brow lift where long incisions across the scalp or at the hairline would be necessary. Nowadays, the vast majority of patients can be treated using endoscopic (keyhole) techniques where small incisions are made in the scalp above the hairline and special surgical telescopes are used to carry out the procedure, keeping the scars very well hidden inside the hair. This is sometimes called an "endobrow".
In men with receding hairlines or a family tendency to this, the procedure may not be suitable since the scars may become visible in areas where the hair is lost. Endoscopic brow lifting is frequently combined with other rejuvenating procedures such as blepharoplasty (eyelids) and facelifting though it can be performed alone.
What does a brow lift operation involve?
What type of anaesthetic will be used?
Browlifting is usually carried out under general anaesthetic administered by an experienced consultant anaesthetist. Patients have the opportunity to discuss the anaesthetic with the anaesthetist prior to the surgery.
What happens when I come into hospital for a brow lift?
You will be admitted to the hospital on the day of surgery and be seen in the ward by Mr Hamilton and his anaesthetist. The areas intended for correction will be re-discussed and some pen marks placed on your skin to guide the surgery.
In theatre, after the anaesthetic has been given, Mr Hamilton will prepare you for surgery, initially tying your hair out of the way (no hair is cut during the procedure). Fluid containing local anaesthetic is placed in the brow to reduce the dept of general anaesthesia required and to increase patient comfort as well as reducing bleeding during the operation. The tissues of the forehead are freed through the small incisions in the scalp and the muscles contributing to wrinkles above the nose are usually weakened. The forehead tissues are then lifted to the desired position and fixed in place before the incisions are closed, usually with dissolving stitches. A very small drain is often placed under the wound to remove any fluid which might collect in the first few hours and this is gently removed the day after surgery. Our anaesthetist will then gently reverse the anaesthetic and allow you to wake up in the recovery are before you are transferred back to your room.
How will I feel after brow lift surgery? How quickly will I recover?
Usually, after a gentle night in hospital, you will be able to go home the following morning, after your hair has been washed. It is best to take things easy, avoiding bending down too much and exercising for several days. Some swelling is inevitable and there can be a little bruising – this usually settles to a large extent over the first few days after surgery. In this particular procedure, a degree of headache is common in the early period after surgery and our expert anaesthetist will ensure you have adequate painkiller medication both in hospital and to take home. Interestingly, many patients with migraine have reported improved migraine symptoms after this type of surgery!
Depending on the exact procedure, you will be seen back at the consultation room 5 to 7 days after surgery when and general advice on recovery and scar management to speed up your progress will be given.
Typically, another review appointment will be made thereafter to see the final result.
Most of the bruising and swelling settles in the first 1-2 weeks and many patients are able to return to normal activities at that stage. Sometimes, things can take a little longer to settle (particularly in patients undergoing more extensive procedures) and it may be wise to allow a little longer just in case.
Is brow lifting safe? What are the potential risks?
Fortunately, the risk of significant, long lasting complications in brow lifting surgery is very small. There are some problems which can develop though these tend to be temporary and short term.
Bleeding under the skin (haematoma) – due to different local anaesthetic solutions and careful anaesthetic technique, this problem is seen less frequently in modern facial rejuvenation. It is seen more commonly in men undergoing surgery and in patients taking blood-thinning medication such as aspirin and other non-steroidal painkillers such as ibuprofen (Brufen) or diclofenac (Voltarol). These medications are therefore best avoided pre and postoperatively. When a haematoma does occur, it may be simply removed by aspiration though very occasionally some sutures need to be removed to wash the area out and the wound reclosed. It does not usually affect the eventual result.
Numbness and nerve damage – some numbness of the brow itself and the scalp above it is usual in the early phase after treatment. A feeling of “pins and needles” is normal as this sensation recovers. The motor nerves which move the face must be carefully protected in facial rejuvenation surgery. Cases of damage to these nerves have been described in the medical literature though it is exceedingly rare. In the vast majority of these, recovery was complete over a period of 2 to 3 months following surgery.
Hair loss – Hair loss is rare with careful technique and more common in smokers. Where is does occur it is typically seen on the scar itself and settles slowly over a few months.
Infection – Infection is rarely seen in facial rejuvenation surgery and routine antibiotics are not required post-operatively. However, as with all surgical procedures, infection occasionally occurs and antibiotics are sometimes needed.
Slow healing – Scars from facial rejuvenation surgery usually heal very well and quickly. Occasionally the wound may be slow to heal. This is fortunately rare even in smokers who are the patients at slightly higher risk of this problem.
Scars – The scars resulting from browlifting are usually very well hidden and the patient can wear any hairstyle he or she wishes. In a small proportion of patients the scars can thicken somewhat usually in the first couple of months (hypertrophic scars) and may need some additional treatment to encourage them to settle.
How long does a brow lift last?
This is a very sensible and common question. In truth, many factors affect this, including the genetic makeup of the patient, the quality of the skin and the surgery performed. It is fair to say that the benefits typically last 7 to 10 years. Although the surgery “turns back the clock” by improving the freshness and youthfulness of the appearance, aging still continues and further change with time is inevitable. Rejuvenation surgery, however, gives long-lasting benefit which persists despite the ageing process.
Summary
For the appropriate patient, browlifting can give very pleasing, long-term results. It can be particularly effective when combined with other facial rejuvenation procedures. With careful planning and attention to detail a less tired, more youthful appearance can be achieved. Mr Hamilton will be happy to discuss your suitability for these procedures at you consultation and to give an honest and friendly opinion on the results which might be achieved