All about the Browlift: Why, When, and How
Browlifts are among the most useful but misunderstood procedures in plastic surgery. Lifting and shaping the brow is often the key to restoring a natural look for the upper face. There are several misconceptions about browlifts (also called forehead lifts), the most common being that they result in a surprised appearance. Not so!
What browlifts do
Often patients come in with a concern about drooping eyelids, thinking that they need the extra skin removed from the upper lid (a procedure called blepharoplasty.) While that is often the case, frequently there is some descent of the eyebrow that is responsible for the appearance of heavy eyelids; in that situation, just doing the “bleph” is a mistake. Here’s a simple way to know if you should consider a browlift: Hold the brow in a pleasing position (not too high) with two fingers; if this improves the eyelids, then a brow lift is the way to go. Sometimes patients need both brow and eyelids done in order to avoid over-doing one of them. (See examples here.)
The other issue addressed by a browlift is forehead wrinkles. These are typically caused by hyperactivity of the muscle that elevates the brow, which in turn may be an unconscious response to droopy brows. By surgically setting the brows where they should be, the muscle can relax and the wrinkles diminish.
When to consider a browlift
Our browlift patients span the age spectrum, but most are in their 40’s through 60’s. Some of the issues that browlifts treat can be managed for a time with Botulinum injections (e.g., Botox, Dysport, Xeomin). But there are limits to their effectiveness as the brows begin to sag, and in some cases they can make the problem worse. Here’s where consultation with a plastic surgeon becomes especially important in guiding the decision.
How browlifts have changed
Back in the day, a browlift was a comparatively radical operation involving an incision across the top of the head behind the hairline. In the mid-90’s the endoscopic version was all the rage, and I did a lot of them. Over the years I found myself doing the “endo brow” less frequently, in favor of the temporal brow lift. Most of my colleagues appear to have made the same shift in approach.
Advantages of the endo-brow: minimal scars, located behind the hairline; ability to de-bulk the corrugator muscle for a botox-like effect on the vertical lines between the eyebrows
Advantages of the temporal subcutaneous brow lift: control of brow shape (see my post on the golden ratio); doesn’t move hairline unless desired; avoids over-elevating the medial brow
Disadvantages of the endo-brow: hairline may move higher; can’t be done if hairline is too high; need for a fixation device such as endotine, which creates visible lumps under the scalp for several months; corrugator can re-grow
Disadvantages of the temporal brow: scar at the hairline; can’t address the corrugator muscles
For most patients, the plusses outweigh the minuses in favor of the temporal brow lift. The scar at the hairline is usually very inconspicuous, and the predictability of the result makes it an essential option for upper face rejuvenation.