About Brow Lift Surgery
At Dr. A Jay Burns Cosmetic Surgery, we offer plastic surgery options for patients wanting to create a lifted brow appearance. Patients usually come to our practice asking for a refreshed look. They often cannot specifically define the anatomic issue but express frustration of “looking tired.” One of the most common causes of such complaints is a heavy, drooping brow. When evaluating and treating a brow, there are 3 problems that can be addressed:
Lateral brow fullness/heaviness/droopiness
Frown lines between the eyebrows
Transverse brow wrinkles
Gravity will take its toll as aging continues, but portions of your brow lift (with regard to the wrinkle lines in the brow and the frown line area) should not be as severe again and may return only mildly over the years. In other words, once the brow is elevated, it will continue to descend each year since gravity naturally takes hold of the tissue. Generally, brow lift patients can expect the effects of the procedure to visibly last at least 6 – 10 years on average.
As we age, skin elasticity decreases and causes various aspects of the face to sag over time. This is especially true in the upper face region and can affect both men and women. Men have brow lifts but not nearly as often due to receding hairlines. The scar is much more problematic and difficult to hide in men. If you feel you appear tired or angry when looking in the mirror, and a subtle lift of that lateral brow with your fingers seems to be an improvement, then a brow lift may be the right cosmetic treatment for you. Finally, if you would like to drastically reduce BOTOX® treatments for your frown and brow lines, then a brow lift may be appropriate to consider. Please note there are no authentic surgical treatments for permanently reducing Crow’s feet, so BOTOX remains the gold standard in this area and its effect is not eliminated with a brow lift.
The usual age range for a brow lift candidate’s start in the early-to-mid 40’s. Most patients who are 50 years of age or older and have never had a brow lift are generally good candidates, but each person must be evaluated as aging rates differ individually.
Plan Your Procedure
- Procedure Recovery Location
As a practicing plastic surgeon involved in both a clinical and academic practice for 30 years, Dr. Burns is trained in all brow procedures, but the choice comes down to endoscopic (limited incision approach) versus an open approach. Dr. Burns exclusively opted for the endoscopic approach for 3 years but has abandoned this method, as he believes it has limitations. Patients were essentially less satisfied with the long-term results of this procedure than they were with the more limited scarring it provided. The pros and cons of each procedure from Dr. Burns' perspective is as follows:
- Endoscopic Brow Lift
- Limited scars
- Less scalp numbness and, in most cases, no scalp numbness is experienced
- The entire scalp is secured in two places and in Dr. Burns’ opinion, the results are not as long lasting
- The scalp is lifted by the layer containing the muscles, which causes the transverse forehead wrinkles. Unfortunately in this case, you cannot treat the transverse wrinkles or even the frown lines through the endoscope as aggressively as other procedures.
- If a patient wants to eradicate brow wrinkles, BOTOX or your filler of choice has to be continued in the frown line and brow areas
- If incisions are placed behind the anterior hairline in order to lift the brow, then the anterior hairline will be elevated, which the majority of patients do not want
- Open Brow Approach
- This is the only approach that can address brow position and all forehead wrinkles simultaneously and most effectively
- The brow is elevated by excising skin from ear to ear. This allows for a more powerful pull and lends to a longer lasting result.
- While not guaranteed for every patient, over 95% of Dr. Burns’ patients do not have a need for BOTOX or filler in their frown lines or transverse frown lines for 10 years post treatment
- Longer lasting brow elevation
- Scar from ear to ear. In all honesty, this is a reasonable point of concern for women. It is a shame that many women dismiss this procedure based on their fear of this scar alone, as it has a very high satisfaction rate and BOTOX needs in this area are greatly reduced in the future.
- Numbness of the scalp: This is temporary in 95% of women in Dr. Burns’ practice and is primarily located in a strip behind the scar approximately 1 - 2 inches wide. Sensation usually returns within 1 year, and it then may often feel like an itch that is difficult to relieve with scratching. In only 1 - 2% of patients is it problematic enough to cause temporary treatment, which is usually Benadryl at night. Again, this symptom is almost always a temporary finding.
The scar is the aspect most often discussed but it is almost never a long-term issue, as the scar is insignificant to 99% of Dr. Burns' patients. There have only been a handful of patients throughout Dr. Burns’ career that have complained of the scar post procedure. When considering the quality of the brow results gained, the overwhelming majority of our patients are very happy with the results of the open brow. He encourages all patients to view his before and after photos online and in-office to determine if they believe the scars to be unacceptable. Almost all women find it difficult if not impossible to detect long term.
In summary, Dr. Burns make decisions in his practice based on long-term satisfaction and has many more happy long-term patients with an open brow approach than endoscopic. However, he always places the patient in control and simply wants them to know the pros and cons of the procedures. A personal consultation is most helpful in making a decision in this area. We encourage our consultation patients to freely contact our patients to speak to them directly and to view more photos in the office. Dr. Burns want patients to get what they want and an honest discussion is critical in order for patients to make the proper decision.
What to Expect
Recovery following brow lift surgery varies. All expectations of postoperative experiences on this website and during consultations describe two standard deviations that patients will experience. Unfortunately, as human beings there are exceptions and some patients recovery may take longer. There is no predicting in advance who that will be. Overall, there will be slight bruising and swelling in the upper face near the brows and possibly around the eyes. Cold compression helps to diminish the swelling and you will be advised to sleep upright for the first several nights following surgery. The average recovery time from this procedure is about 2 – 3 weeks. The outcome can usually be seen immediately, but be warned that brow elevation is usually slightly exaggerated early in the process as swelling causes the brow to rise above the long term desired position. The brow results should result in a rejuvenated natural appearance that looks softer, more alert, and with a noticeable reduction in fine lines and droopiness of the brow.
All information below is based on an average patient, including 2 standard deviations (95% of all patients). Some of our patients fall outside these descriptions and will have a better or worse recovery than the average patient, for unexplained reasons.
Pain is typically not a significant problem in brow lifts. There is, however, some discomfort and tightness from ear to ear across the top of their head and across the brow and, if apparent, is most noticeable in the first 3 days.
Drains are usually not utilized when doing a brow in isolation. Brow drains are used when done in combination with a face-lift, which is commonly combined.
Maximum swelling occurs 48 – 72 hours post-surgery and begins to subside on day 4 or 5 after the operation. Most noticeable swelling is gone by 3 weeks and 95 percent of swelling is gone by 6 weeks, but 100 percent of swelling is not resolved until 6 months in most cases.
Interestingly, bruising on a brow lift appears commonly around the eyes, in the most dependent areas. As a result, any bleeding usually collects below the eyelids and bruises the lower lids (even if the lower lids are not operated upon). Bruising is usually maximized on day 3 – 5 and resolves over 2 – 3 weeks.
There is no absolute time that driving is restricted; there are only reasonable guidelines. The patient must take full responsibility for the decision to drive. That decision is predicated purely on your ability to drive and ability to not cause harm to others. You can be a liability so when you feel comfortable that you can see blind spots, have the range of motion to manage full, accurate vehicle control then you can drive. A rough guideline to manage expectations is that most patients begin to drive within 1 to 2 weeks post operation, but everyone is different.
Most patients feel very comfortable physically in returning to work a few days after an isolated brow lift. However, a socially comfortable return is usually the source of a long return. As swelling around the eyes can be noticeable, a two-week return is normal but may take as long as 3 weeks in some patients depending on their own personal comfort level and work demands. The average patient can return to work within 10 days, with the help of a little make-up. If bruising is minimal, the return to work can be even earlier.
Sensory nerves run close to and within the muscular layer that’s eliminated during a brow lift. As a result, some partial numbness may be present for several weeks post-surgery directly in the brow itself. Numbness behind the incision in an open brow lift has been discussed above at length.
Rejuvenate Your Appearance
Dr. Burn's main goal on any face lifting procedure is to avoid an "operated" look. A natural refreshed look is always the goal but it does take a reasonable amount of time to allow swelling to resolve. Fear of "the startled look" causes many patients to avoid exploring a brow lift altogether. When done properly however, brow lifting is one of the most gratifying and rewarding procedures that Dr. Burn’s performs. We hope you will come in for a private, individualized consultation for a brow lift. Consultations are to educate you fully without pressure in order for you to make the best decision for you.