The aging brow takes on a “tired” and sometimes “angry” look. Furrows between the eyes appear, transverse forehead lines develop, and the eyebrows descend. A properly performed brow lift can treat these complaints without creating a “startled-look.” Dr. Wallach tailors multiple different brow lift procedures to accommodate his patients needs. A non-surgical lift can take ten to twenty minutes with little to no downtime using filler materials and/or Botox/Dysport, while a more permanent lift using various surgical techniques usually takes between one to two hours with a recuperation time of seven to ten days.
A good candidate is a person who is otherwise healthy and complains about sagging of the eyebrow which might cause lateral upper brow hooding, about transverse forehead wrinkles and vertical forehead wrinkles between the eyebrows.
The fee will vary by the technique used. The fee might range from $7500-$12000.
During the consultation, you will spend a lot of time with the doctor reviewing your surgical goals. An exam will then be performed and a surgical plan will be discussed with you at length.
A brow lift is a very safe procedure with few if any risks of complications. Most common early post-operative issues include some scalp numbness, bruising, and swelling. Hair loss at the incision site can occur as well, but this is often temporary.
Brow lifts are often performed under sedation or general anesthesia. The forehead and scalp are injected with local anesthesia and then the procedure is performed either through several small incisions in and around the scalp for an endoscopic brow lift, or through a transverse scalp incision for an open browlift. Modification of the incision will depend upon the patient’s anatomy. The brow can then be lifted and the underlying muscles can be treated. The scalp is elevated by either using supporting devices like endotines or sutures, or by removing some scalp skin. The incisions are then closed and a loose dressing is wrapped around the head.
Surgical options to treat aesthetic brow issues come in two basic varieties: Open techniques or Endoscopic techniques. Both are excellent approaches to treat the brow, but as with everything a plastic surgeon can offer, the surgical technique must be tailored to the patient’s anatomy and their goals. Therefore, not all procedures are appropriate for everyone. So why one technique over another?
A browpexy procedure is performed through an upper blepharoplasty (eyelid) incision. This is a limited incision approach to suspend the brow to the forehead. Often this is done with sutures but can be done with mini-endotines as well. The endotine is a device that looks similar to a carpet tack and is secured to the outer layers of the skull. The brow is elevated and secured to the endotine to provide the brow elevation.
- Limited incision, treats lateral hooding of the eyebrow.
- Only treats lateral brow descent.
The direct brow lift is a modification of the open procedures in which a limited incision is used. This requires an incision just above the eyebrow. An ellipse of skin only is removed to raise the position of the eyebrow.
- Limited incision hidden along the upper border of the eyebrow, can be done under local anesthesia, good for bald patients.
- Does not treat forehead lines significantly, does not treat Glabellar or “11” lines.
This is a limited incision approach using three to five small incisions hidden in the hairline. When using this approach a small camera is inserted to allow visualization of the brow region; this eliminates the more traditional incision that extends from ear to ear across the scalp. The brow descent can be treated, the central glabella “11” lines can be treated, and the transverse forehead lines can be softened. The forehead is raised and secured superiorly. Some surgeons create little tunnels in the outer skull surface to secure the scalp with sutures. Dr. Wallach prefers using tiny devices called Endotines to provide fixation. The Endotines look similar to small carpet tacks. They are a great addition to the tools available for brow lifting. However, in some instances, Dr. Wallach may use cortical tunnels, which are tiny drill holes in the scalp, to elevate the brow.
- Limited incision procedure, lower risk of alopecia (hair loss), and lower incidence of scalp numbness.
- May not treat transverse forehead wrinkles as well as with the open technique, may get some return of brow ptosis (droop) due to inadequate fixation or from gradual return of forehead descent.
Is a modification of an open brow lift in which a limited incision is made in the lateral hairline, many times this can be accomplished by extending the facelift incision in the temporal hair line. This allows for improvement of the lateral brow by elevating it and improving lateral brow hooding.
- Limited incision procedure, and decreased risk of scalp numbness.
- Will not treat Glabella “11” lines or transverse forehead lines, will not address discrepancy of short or long forehead adequately.
A mid-forehead lift is similar to a direct brow lift in that it is a modification of the open procedures in which a limited incision is used. This requires an incision within mid-forehead crease lines. An ellipse of skin is removed to raise the position of the eyebrow.
- Limited incision hidden within a natural transverse forehead crease, it can be done under local anesthesia, it can be performed on bald patients.
- Will treat forehead lines better than a direct brow lift, it does not usually treat Glabellar or “11” lines.
Open Brow lift techniques are used for patients that want a longer lasting result than with neuromodulators and fillers. Open brow lift techniques can treat the transverse forehead lines by trimming some of the muscle that causes them. It can also treat the “11” lines by undermining them from inside or removing some of the corrugator muscle that causes them. Of course, brow elevation is also performed. Incisions are designed based upon the patient’s anatomy. For instance if a patient has a low lying hair line, a coronal incision which is placed a few centimeters behind the hairline is performed so that the forehead is lengthened and provides a better balance with the lower two-thirds of the face. The incision is hidden in the hairline but will remove some hair. An anterior hairline incision which is placed along the front of the hairline is performed for the opposite reason when the forehead is too long. This preserves the hairline and shortens the forehead and can even bring the hairline lower to improve the facial balance. Modifications of these incisions such as a modified coronal or modified anterior hairline incision can take into account for long or short foreheads with thinning hairlines, or even baldness. Learn more about open vs endoscopic brow lift surgery.
- Often the longest lasting results for all brow lift techniques, less or no need for further neuromodulator/filler use for the brow, better treatment for deep furrows, long lasting facial balance.
- Some scalp numbness that usually improves with time, an incision scar (coronal incision hidden in hairline), some downtime after surgery, will remove some scalp hair using a coronal incision.
Otherwise known as a Chemical Brow lift, this can be achieved with the common neuromodulators, BOTOX®/Dysport. There are several things that can be accomplished during a non-surgical brow lift. The “11” lines are deep furrows in between the eyebrows caused by overactive corrugator muscles. The deep transverse forehead lines are the result of the overactive frontalis muscle, and the lateral crow’s feet are due to the overactive orbicularis muscle around the eye and present as radial lines at the corners of the eyes. When using the neuromodulators, the muscles that cause these deformities can be neutralized for four to six months at a time. In treating the lateral eyebrow region near the crow’s feet, the lateral upper brow can be lifted. Using the neuromodulators regularly will help minimize the risk of deep “etching ” of the skin that happens with repeated motion in those regions seen especially frequently between the eyebrows. The “etching” occurs from the repeated motion and the atrophy of the soft tissue between the skin and underlying muscle. Sometimes a combination of treatment using filler material like the hyaluronic acid products (Restylane™, Restylane Lyft, and Juvederm™) will improve the “etching.” In addition, the filler materials can be used to raise the lateral brow by filling the area near the eyebrow. In addition, some patients have what is called temporal wasting along the side of their brow which can be treated again with fillers or Sculptra. These products are not permanent and have to be repeated a few times per year.
- Many patients love these products because the fillers last between six and twelve months and the neuromodulators last between four to six months, there is very little to no downtime after injection, the injection of these products does not require a surgical procedure, and there may or may not be minor bruising and/or swelling.
- The results are not permanent, the neuromodulators may cause brow or eyelid ptosis, the filler products may be noticeable in some instances, they do not work well for severe forehead ridging.
“Beauty is the internal light that emanates from within. To me, the true form of beauty is one’s personality that shines through.”Steven Wallach, MD
The recovery is usually very straightforward. A small drain may have been placed and this is often removed within a few days of the procedure. Scalp sutures or staples are usually removed within 7-10 days. Patients are recommended to limit exertion for several weeks but can go back to light duty within a week.