Some people think of a brow lift as a purely cosmetic procedure. What are the medical reasons a person might need a brow lift?
Most people come to our clinic complaining that their eyelids droop so much that they obstruct their vision. For some people, their eyelids are so low that their eyes look half closed when they are fully open, so they actually have to raise their eyebrows to see properly.
The eyebrows are supposed to be just above or just above the brow bone, also called the supraorbital ridge or brow ridge. I tell patients who come in to close their eyes and relax their face as much as possible before pressing on their brow — and many times, they’re pressing on their eyeball because their forehead has dropped so much.
When you do a brow lift, do you normally also operate on the eyelids?
It depends. When lifting the eyebrow, if the eyelid is in good position and there is no excess skin to obstruct vision, then we will not do it. When I lift the brow, if there is still a drooping eyelid because the muscle has slipped or there is excess skin, then we may do a combination procedure, such as blepharoplasty or drooping.
Not everyone realizes that some eye doctors, especially ophthalmologists and eye surgeons, can perform brow lifts. Can you explain the type of training ophthalmologists like yourself receive to perform this type of surgery?
Ophthalmological plastic surgeons go through medical school and complete training in ophthalmology. Our main priority from this training is to ensure that patients’ eyes are safe and that their vision is either better or improved when performing procedures. After the residence, we complete two additional years of training in ophthalmoplasty and facial surgery. Us main focus those years it is the soft tissues of the eyelids, eyebrows, eye socket, and midfacial structures.
Are there certain brow lifts that are only performed by facial plastic surgeons vs. ophthalmoplastic and orbital surgeons?
No, both types of surgeons can perform a brow lift. However, I think most functional eyebrow lifters hectare performed by ophthalmic and orbital surgeons based on their ophthalmic training, and I recommend that patients go to a surgeon who has extensive experience in brow lift.
How many different types of brow lift are there?
There are many. There is a direct brow lift, where an incision is made just above the brow hairs, and we lift the brow by directly removing some skin and then closing it. We try to hide the incision as much as possible, but it is visible.
For patients with deep forehead wrinkles, we can hide an incision in a forehead wrinkle through a mid-forehead brow lift. You are essentially hiding the scar within the wrinkle.
A pre-hairline brow lift is where we make an incision at the hairline to lift the brows and skin. This may be a better option for people with thick hair and bangs, but it’s not something we’d recommend performing on someone who’s balding because these are larger scars that will be visible unless they can be hidden in one’s hairline.
An endoscopic brow lift is where we make several tiny incisions behind the hairline. We insert an endoscope into one of the incisions to see the tissues and muscles. Then we use another device placed in a different incision to make alterations to lift the eyebrows and some wrinkles on the forehead.
We can also do an internal browpexy, which is a more minimal procedure. We make an incision in the eyelids and lift the brow with an internal suture to help suspend the brow. But in my opinion, this process does not always produce such a natural result and is not so long-lasting. I rarely perform this and it is usually only a good option for a patient whose brows are partially drooping along the outer browbone.
At the 29th Annual Sue Anschutz-Rodgers Eye Center Symposium, you and your colleague Daniel Ozzello, MD, discussed the pros and cons of an endoscopic versus direct brow lift. You advocated an immediate brow lift — why is that?
I probably do the most direct brow lifts of anyone in our practice and I think they are great. And as long as patients keep their incision out of the sun for about six months, then the scar usually heals very well.
Also, insurance is more likely to cover an immediate brow lift. An endoscopic brow lift will likely not be covered because it is generally considered a cosmetic procedure rather than a functional one. Direct brow lift is more of a functional surgery with the advantage of anatomically correcting where the brow is located, but has a visible scar. This is why this surgery is usually reserved for older adults.
What are the most common types of brow lifts performed at your office?
In my practice, for the vast majority of patients, the debate is often between either a pre-hairline brow lift or a direct brow lift. The added benefit of a pre-hairline brow lift is that if patients have deep wrinkles on their forehead, you can help remove some of those wrinkles by pulling the skin toward the hairline.
In general, how is the recovery process of the brow lift?
If we just do a simple brow lift with nothing else, recovery is usually easy. The patient may experience some bruising, but I have never complained of blurred vision from a simple eyebrow lift. The stitches are usually removed about a week after the procedure. For the first two to three months, the incision site is a little more visible before the scar matures. With a prehair brow lift, there may be a little longer initial downtime due to the larger incision.
How will you work with your patients to decide which type of brow lift is the best option for them?
With my patients, I present them with all the information, including the estimated cost, recovery process, potential risks and benefits, and what the side effects might be. We discuss their goals and what are acceptable outcomes for them. For example, I’ve had patients who decided they didn’t want to have a direct brow lift because they were concerned about the scarring it might create, so instead, we decided to focus on a procedure just for their eyelids.
It really comes down to patient preference and I prioritize tailoring my approach to fit their informed decisions.
