Brow Lift Surgery
Are you tired of deep creases across your forehead? Do your brows look hooded? Maybe others think you look angry? Do you see a lot of excess tissue in your upper eyelids? A brow lift from Houston facial plastic surgeon Dr. Raghu Athré tightens and refreshes your natural appearance.
What is a brow lift?
The eyebrows frame the eyes and help shape the overall look of the face. Since the eyes are one of the most important focal points of the face, aging in the region of the eyes ages the entire face as well.
Brow lift surgery has many synonyms including forehead lift, eyebrow lift, and cat eye surgery. The purpose of a brow lift procedure is to lift the brows, open the eyes, and make the eyes seem more awake and alert.
Brow/Forehead Anatomy
Underneath the skin of the forehead is a tissue layer and a muscle layer. The muscle layer, or the frontalis muscle, holds the brows up. This muscle is used when we squint or when we exhibit a look of surprise.
The tissue layer is made up of a matrix of collagen and elastin, which gives the forehead its youthful fullness. As aging occurs in this area, the collagen and elastin degrade. The natural force of gravity is a downward pull, which causes the brow tissues to fall downwards.
To compensate, the frontalis muscle contracts to lift the brows up. Initially, the muscle is able to compensate for the downward pull of the brows. Over time, the chronic contraction of the frontalis muscle causes furrows or lines in the skin of the forehead. Eventually, the frontalis muscle is not able to compensate leading to:
- A lowered position of the brows
- Increased fullness in the brow region
- Increased fullness of the upper eyelid region
A simple procedure called a brow lift can be performed to bring the brows near to their youthful, natural position. A well planned and executed brow lift procedure will account for both the tissue and muscle layer. The goal is to subtly elevate the brows, smooth the forehead skin, and achieve an appearance that looks naturally more youthful.
Non-Surgical Approaches to the Brow – Brow lift without surgery
The primary nonsurgical therapy addressing aging of the brows is BOTOX®, Dysport™ and other neuromodulator agents.
In the early stages of brow aging, BOTOX can be used to address mild aging of the brows and forehead wrinkles by relaxing the frontalis muscle. If injected carefully, BOTOX can relax the forehead lines, and result in a smooth forehead. Botox can also be injected into the brow depressor muscles (the corrugator, and the crow’s feet portion of the orbicularis muscle) giving the BOTOX brow lift. Injection of these muscles will prevent the muscles from pulling the brows down and will result in a 1-2 mm elevation of the brows.
BOTOX cannot be used to treat moderate or severe brow aging.
ELF Brow lift and makeup techniques
Patients primarily wanting to shape their brows may use makeup products such as E.L.F. Brow lift gel. These types of products including tattoos do nothing to actually lift the brows. They merely give the appearance of a shaped, lifted brow – which might suffice for minimal brow aging.
Read the Transcript
Now, so far we’ve talked about upper one-third facial rejuvenation, including brow lift and blepharoplasty. Let’s dive in a little bit more detail into these categories, brow lift.
So what actually happens here? So when we look at this area, we’ve got, and again, go in terms of anatomy, we have our skin, underneath the skin is a muscle right here. And that muscle is called a frontalis muscle. That frontalis muscle is important for lifting these brows up, for me doing that. So as I’m doing that, that frontalis muscle is essentially contracting and lifting my brows up.
There are other brow elevators, but for the most part, it’s the frontalis muscle. Now, if you look at a baby or someone very young, almost no one has lines in this region. Over time, what happens is that muscle and all the tissues as they fall, that brow tends to come down. As that brow is coming down, this sends a signal to our brain to pick them up, pick them up, pick them up. As we continually pick them up, we end up developing lines in this area.
Now, some patients in the early process of that spectrum will say, Hey, I got lines in this area. What can I do? You can give them a little bit of Botox to make the lines go away. Now, the Botox or Dysport, dealer’s choice, is really a Band-Aid type of cure. It’s not fixing the problem. It’s really covering up the symptom, which is the line.
Now, as that process goes down the road and the patient’s brow ptosis becomes more severe, you’re going to need to do something more than Botox. Because if you just inject Botox to make these lines go away, you’re actually going to make the problem even worse because now that muscle that’s lifting the brows up can’t work, so their brows get even lower.
So there’s a whole lot of different types of brow lifts. Going in order, there is a direct brow lift where there’s an incision that’s done right in the eyebrow line. There’s a mid-forehead brow lift where incisions are made right in one of these deep creases. There’s a trichophytic brow lift where the incision is made right in the hairline. There’s a bicoronal brow lift where the incision is made like a halo from ear to ear. Then there’s an endoscopic brow lift where the incisions are made are tiny incisions inside the hairline. And then there’s sub variations of those.
Most of the time, what I like to do is a combination endoscopic temporal brow lift. I smash those together and that’s most of the time what I do. The temporal brow lift is made in an incision right along the hairline right in here, inside the first couple of rows of hair. That way I can dissect down to here and lift the corner of that brow up. So most women like the corner of the brow to be lifted up so they have a little bit of angulation to the brow and that’s done through that incision.
Yet almost everybody also needs a little bit of the medial elevation and that’s done through a tiny incision back here in the scalp. The reason why I like this combo brow lift, it gives the best durability and long term viability with the best cosmetic outcome. Some of the other procedures, like a direct brow lift or a trichophytic brow lift, do tend to have a scar for a significant period of time. It eventually fades away, but takes quite a while for that to happen. So this is my rationale. This is what I like to do. So if you come in and you have aging in the upper one third of the face and I see that you’re a candidate for brow lift, most likely I’m going to recommend doing a combination endoscopic with the temporal brow lift.
Brow Lift Surgery Procedure
Before a brow lift consultation in Houston at Athré Facial Plastics, patients will be asked to bring in a picture of themselves at age 20-25. This picture serves as a benchmark to customize the correct procedure to achieve the desired results. Some patients have a genetic low brow with increased fullness of the upper eyelid area. Functional, anatomical, and aesthetic goals are all reviewed to ensure a positive result. In some cases, eyelid surgery may also be performed to further “open up” the eye area.
Immediately prior to the procedure, the amount of brow lifting and the arch and contour of the eyebrow are specifically marked on the forehead. The procedure elevates the brow by lifting the tissue and the muscle. Several brow lift techniques exist, and the choice of technique is tailored to each patient after taking into consideration the patient’s anatomy, gender, natural brow shape, and background.
See a Video of This Surgery
Before & After Photos
Types of Brow Lift Surgery
Endoscopic Brow lift and Modified Endoscopic/Temporal brow lift
The endoscopic brow lift technique uses small incisions hidden within the hairline. Normally 4 incisions are used. The first two incisions are directly above the medial portion of the brow within the hair line. The other two incisions are approximately at a 45 degree angle from the lateral brow in the intersection of the hair and non hair-bearing skin. The endoscopic brow lift is the technique that Dr. Athre uses most frequently to lift the brow complex.
The advantages of this technique is that the incisions are completely hidden inside the hair line. Hence, this type of brow lift definitely gives the best cosmetic outcome.
In the past, endoscopic brow lifts have had some complaints with respect to how long they last. These endoscopic brow lift failures usually had incomplete dissection and a single absorbable point of fixation. Dr. Athre’s Modified Endoscopic/Temporal brow lift technique offers all of the benefits of amazing cosmesis, no scars and excellent long-term durability.
Modified Athre Endoscopic/Temporal Brow lift 6 months before/after
Direct Brow Lift
A direct brow lift uses an incision in the brow itself.
This type of brow lift is also very effective. It is also quicker, and easily performed under local anesthesia. The primary disadvantage of a direct brow lift is the scar. The scar does camouflage and diminish over time. However, this process can take up to 4-5 months in total.
Appearance of scar 2 months after direct brow lift. The scar will continue to disappear over the next 4 months.
The fact that this brow lift is easiest and takes the least amount of time makes the direct brow lift the cheapest of all brow lifts. This type of lift is primarily used for older men.
Coronal Brow Lift
Diagram of coronal incision. Source
The coronal brow lift uses an incision from the root of the ear to the root of the ear on the other side. The primary advantage of this type of brow lift is that it is very effective since the surgeon has complete visualization of all anatomic structures, and can effectively lift the brows. The primary disadvantage of this technique is that it is extremely invasive, has significant postoperative swelling, and long term results offset by the significant scar and loss of hair in the scar line. This technique is rarely used by Dr. Athre for these reasons.
Brow lift Anesthesia
Most brow lift procedures are performed under local anesthesia with oral sedation.
The brow area is relatively easy to anesthetize with local blocks. The advantage of this type of anesthesia is quicker recovery after the procedure, but also real-time examination in the operating room for symmetry.
In patients that are extremely nervous, the brow lift surgery may be performed under general anesthesia. The main factors that make this decision are:
- Patient medical history
- Patient comfort with local anesthesia
- Patient anxiety and personal preferences
Brow Lift Recovery and Results
Patients are allowed to go home the same day. The recovery time for a brow lift procedure is roughly 1 week.
Incision sites are unnoticeable within about a week, and patients can return to full normal activity near the 5 to 7 day mark. Swelling and bruising resolve to the point where makeup can be worn within 7 days. Full healing and complete resolution of swelling should dissipate in a few weeks and your best results may take several months to completely reveal themselves.
Brow lift vs. Eyelid surgery
Aging of the brow complex, and aging of the eyelid complex can cause a heavy upper eyelid. To determine whether a patient needs upper eyelid surgery (blepharoplasty), brow surgery, or both brow lift and eyelid surgery requires careful physical examination.
In your initial consultation appointment, Dr. Athre will perform a detailed examination to determine which of the above procedures will be best for you. Patients with mild aging of the brow, relatively good shape of the brow, brow position above the orbital bone, and primarily with excess skin of the upper eyelid may only need an upper blepharoplasty. On the other hand, patients with significant excess skin of the upper eyelid with a very droopy (ptotic) brow will likely need combination brow lift and eyelid surgery to achieve the optimal result.
Client Testimonial
“Couldn’t be any more pleased! I came in with a mindset of what I was expecting and they surpassed my expectations! His staff made me feel so comfortable along the way. Dr. Athre was so kind and makes sure you know what’s going on during the procedure. To anyone contemplating a procedure, go in for a consult and just do it!”
Schedule a Consultation
- Comprehensive Consultations: In Houston TX, cosmetic surgery begins with personalized consultations where patients discuss their aesthetic goals with experienced surgeons.
- Advanced Procedures: Leading cosmetic surgeons in Houston TX utilize state-of-the-art techniques and equipment to perform a wide range of procedures tailored to each patient’s needs.
- Facial Rejuvenation: From facelifts to Botox injections, Houston TX offers various options for facial rejuvenation to restore a youthful appearance and enhance facial features.
- Body Contouring: Patients can achieve their desired body shape through procedures such as liposuction, tummy tucks, and breast augmentation.
- Breast Procedures: Houston TX specializes in breast surgeries, including breast lifts, reductions, and augmentations, to address concerns and enhance breast appearance.
- Minimally Invasive Options: For patients seeking less invasive treatments, Houston TX offers options like dermal fillers, laser therapy, and nonsurgical body contouring.
- Customized Care: Each patient in Houston TX receives personalized care and attention throughout their cosmetic surgery journey, ensuring optimal results and satisfaction.
- Post-Operative Support: Following cosmetic surgery, patients receive comprehensive post-operative care and guidance to promote healing and long-term success.