Brow lift

A brow lift is cosmetic surgery to correct a sagging or deeply furrowed brow. The operation is often performed to reduce the creases, or ‘frown lines’, that develop across the forehead and on the bridge of the nose. It can also raise the eyebrows to a more alert and youthful position. This type of surgery is also known as a forehead lift.

Other ‘rejuvenation’ or cosmetic treatments often performed along with a brow lift are facelift surgery (to correct ageing changes in the mid to lower face and neck regions), eyelid surgery (to rejuvenate ageing eyes) and skin resurfacing techniques.

If you are concerned about the way you look or are thinking about cosmetic treatments to boost your confidence, there are alternatives. These may include lifestyle changes or accepting yourself the way you are.

Issues to consider before brow lift surgery

Before you opt for brow lift surgery, some important issues to keep in mind include:

• If you are most concerned about the area around your eyes, you may want to discuss other options with your doctor such as eyelid surgery to rejuvenate ageing eyes.
• The results of a brow lift are sometimes permanent. However, the effects of ageing or any major changes in your weight after surgery could affect how you look.
• Think about the financial cost. Cosmetic surgery does not usually qualify for rebates from Medicare or private health insurance companies.
• Smokers are at increased risk of complications from any surgery. If you are serious about undergoing cosmetic surgery, you should try to quit smoking.

Finding a medical practitioner to perform a brow lift

You may want to ask your doctor for advice on a suitable and reputable medical practitioner or hospital where brow lift surgery is performed. At your first consultation, you should ask the medical practitioner about their training and experience. It is preferable to have this procedure done by a medical practitioner who is specially trained to perform brow lift surgery and has a lot of experience in carrying out this type of surgery.

Medical issues with brow lift surgery

Before the operation, you need to discuss a range of medical issues with your medical practitioner. They will talk to you about your:

• Physical health– an examination will help your medical practitioner to decide if the treatment is appropriate.
• Medical history – some pre-existing medical conditions and surgery you’ve had in the past may influence decisions about this operation, including the type of anaesthetic that is used.
• Risks and possible complications – it is important that you understand the risks and complications so that you can weigh up whether brow lift surgery is right for you.
• Preparations and supplements– tell the medical practitioner about any medication that you take on a regular basis or have recently taken, including over-the-counter preparations such as fish oils and vitamin supplements.
• Past reactions to medication – tell the medical practitioner if you have ever had a bad reaction or a side effect from any medication, including anaesthesia.
• Preparation for surgery – your medical practitioner will give you detailed instructions on what you should do at home to prepare for surgery. For example, you may be advised to take a particular medication or alter the dose of an existing medication. Follow all instructions carefully.

Brow lift operation

Brow lift surgery can be performed under a general or local anaesthetic. There are two techniques that can be used, both of which can take up to two hours.

The two main types of brow lift are:

• Open (or ‘traditional’) brow lift – the medical practitioner makes a long incision (cut) across the forehead, either around the hairline or in one of the creases of the forehead. The skin is lifted away from the underlying tissues. Muscles are loosened and fat is removed. The medical practitioner removes any excess skin, pulls the remaining skin down and stitches the brow into its new position. Other names sometimes used to describe this operation include classic, coronal or trichophytic brow lift.
• Endoscopic brow lift – the medical practitioner makes several smaller incisions and inserts an endoscope (a metal tube with a camera attached to the end). The operation is similar to that used for an open brow lift, but the medical practitioner observes the tissues underneath the skin on a television screen rather than through an open wound.

An alternative form of facelift surgery that is often done using local anaesthetic is a suture brow lift (thread lift) where the medical practitioner inserts fine threads with tiny ‘teeth’ through very thin tubes (cannulae) so no cuts are made in the skin. These threads are made of a non-absorbable medical prolene fibre that has been used safely for many years in surgical operations.

Once the threads have been positioned through the tiny puncture sites, the threads are then gently pulled upwards and secured to the facial tissue and skin. The insertion point is then stitched shut.

Immediately after the brow lift

After the operation, you may expect:

• a drainage tube in the wound to help prevent fluid build-up
• bruising and swelling
• possible numbness
• pain and discomfort
• dressings or bandages on your face.

Complications of a brow lift

All surgery carries some degree of risk. Some of the possible complications of a brow lift include:

• risks of anaesthesia including allergic reaction, which may (rarely) be fatal
• surgical risks such as bleeding or infection
• blood clots that may cause potentially fatal cardiovascular complications such as heart attack, deep vein thrombosis or stroke
• collapsed lung
• hair loss along the wound
• tissue death along the wound or skin loss
• severe or inflamed, itchy scarring
• rough skin
• surfacing of stitches through the skin
• uneven skin contours
• permanent facial pain
• nerve damage, which can cause temporary or permanent paralysis of part or all of the movement of the forehead muscles – this could leave you unable to raise your eyebrows or wrinkle your forehead
• numbness of the brow, which may be temporary or permanent
• uneven results – for example, eyebrows are asymmetrical or don’t line up
• further surgery to treat complications.

Complications of suture brow lift

Some of the possible additional complications of a suture brow lift (thread lift) include:

• thread movement – this may lead to the thread extruding, breaking or losing its hold on the skin
• puckered skin
• discomfort, if the threads are felt under the skin
• skin irregularities or a loss of eyebrow symmetry
• infection (this is rare)
• more extensive surgery – if removal is required because of infection, discomfort or an unsightly appearance.

This is not a complete list. For example, your medical history or lifestyle may put you at increased risk of certain complications. You need to speak to your medical practitioner for more information.

After surgery

Be guided by your care of yourself at home after brow lift surgery, but general self-care suggestions include:

• Follow all instructions on looking after your wounds.
• Don’t bend over for at least three weeks.
• Avoid unnecessary stress on your wounds – for example, don’t wear tops that must be pulled over the head.
• If you have had a suture brow lift (thread lift), take care to avoid excessive facial movements and frowning in the first few weeks to make sure that the very fine threads stay in their original position. This is important until the body develops a tissue reaction around the fibre, which strengthens and holds the facial tissue in its new position.
• Report any bleeding, severe pain or unusual symptoms to your medical practitioner.
• If necessary, take pain-relieving medication strictly as directed.

Long-term outlook after brow lift surgery

Effects that you can expect depend on which operation you have had, but generally include:

• Traditional or limited incision non-endoscopic brow lift – the swelling may take months to subside. Scarring will be permanent, but should fade in time. Be patient – improvements to scars may take around a year or so.
• Suture brow lift (thread lift) – some pain may be experienced, but the discomfort usually settles within 24 hours. There have been some reports of more severe pain after the operation. There may be slight swelling and bruising for four to 10 days.

Remember, a brow lift does not change your fundamental appearance and cannot stop the ageing process. Although the results are permanent, your skin will continue to age. A healthy lifestyle and taking steps to minimise your daily exposure to sunlight will help maintain the results of your surgery. You can expect that the brow and forehead should appear firmer and less lined.

Alternatives to brow lift surgery

Alternatives to a brow lift can include:

• dermal fillers or injections into wrinkles
• laser resurfacing
• accepting yourself – talking to a counsellor or psychologist may help you overcome your concerns and you may decide that you like yourself the way you are.

Where to get help

• Your GP (doctor)
• A medical practitioner specially trained and experienced in performing cosmetic surgery
• Cosmetic surgery hub and hotline, Australian Health Practitioner Regulation Agency (AHPRA) Tel. 1300 361 041
• Cosmetic surgery, Department of Health and Aged Care, Australian Government
• Australian Society of Plastic Surgeons Tel. (02) 9437 9200
• Royal Australasian College of SurgeonsTel. (03) 9249 1200