Brow Lift

Brow position has the biggest influence on the emotional message that the face conveys. The brows should be situated just above the bone medially (i.e. on the nose side) and well above the bone laterally (on the outside, the tail of the brow). They should have a gentle arch, peaking at the outer edge of the colored part of the eye (see the picture of Charlize Theron who shows good eyebrow aesthetics). With aging, the brows may droop due to the effect of gravity or they may go the other way and be pulled up because of reflex muscle action (see below)..I am wary of creating over-lifted brows which can make you look anxious or surprised. I like to sculpt the brow to suit your face and create a look that you like. At consultation I will discuss ideal brow position for your face and methods to achieve this.

Low brows can therefore occur in young or older women and are not necessarily a sign of aging, but elevating and surgically shaping the brows can open a face and the eyes, improve a tired or angry appearance, help with frown lines and crow’s feet and give your face a more attractive and fresh look. Prior to suggesting a browlift to you, I will sit you down in front of a full mirror and show you what the effect of surgery will be. Patients do not usually want a surprised or anxious look and the modern kind of browlift that I do as well as the pre-operative counselling will avoid this.

Elevating the brows can be feminising in men and so I prefer not to offer brow lifts to my male patients.

The traditional browlift used to be done with an incision along the whole hairline of the forehead. This left a long and unsightly scar and created an unnatural forehead and brow.

Endoscopic browlifts are popular but in my opinion are conceptually flawed. Most patients who require a brow lift require more elevation of the outer brow than the inner brow - the exact opposite of what an endo brow achieves. (An endo brow divides the muscles medially to create medial elevation of the brow.) Fixation can be problematic with an endoscopic brow lift and it has been shown that over time the brows continue to elevate and ride up the forehead.

I therefore do what is called a suture suspension brow lift. I have presented (International Society of Aesthetic Plastic Surgeons Meeting, Cape Town, March 2008) and published (Plastic and Reconstructive Surgery, April 2010) on this technique.

Changes in Eyebrow Position and Shape with Aging and Brow Lifting
Lazarus, Dirk. Plastic & Reconstructive Surgery. 125(4):1291-1292, April 2010. doi: 10.1097/PRS.0b013e3181d45aee

A suture suspension brow lift is a relatively simple procedure which is performed as day case surgery (in and out on the same day) in my own private facility. Sedation is usually given, but the surgery is performed under local anaesthesia. The whole procedure takes under an hour. Two small (1 cm) incisions are made at the hairline on each side. The skin is elevated to allow the brows to be suspended. Multiple thin permanent sutures are then placed to suspend the brow in position. These sutures prevent the brow from descending but still allow you to elevate the brow to express surprise and other emotions. Once the brows have been suspended and shaped, the cuts are closed. Surgery is performed in the morning and you will recover in the afternoon. Once you are up and about and I have assessed you as being ready, you will be discharged home with some light plasters above your eyebrows and painkillers.

You will feel some tightness in your forehead for a number of days. You may get some bruising and swelling which will last about a week. You may also have some bunching of skin above the eyebrow which may take a few weeks to settle. Some patients experience some scalp numbness which usually improves.

Problems which can occur with suspension brow lift include asymmetry, too much or too little lift and a headache which can be severe in the first few days. Nerve injury causing paralysis of the forehead is also a potential but very rare complication with any forehead lifting procedure.

The sutures are removed at about day 10 post-operatively after which out of town patients can return home. The scars are minimal and inconspicuous and the effect of the browlift is likely to be long-lasting. A browlift can be done as a stand-alone procedure or combined with other facial rejuvenation or enhancement surgery.

My brows are too high and I have forehead wrinkles

Frequently with aging as the eyelids become more baggy they come to rest on the lashes. This provokes a reflex in the forehead muscles which then contract to lift the brows. The muscle activity also creates horizontal forehead lines. To treat this I treat the muscle refelx of the forehead with botox. This may cause the brows to descend, either to normal levels or too low and is likely to make your upper lids feel baggy. The surgical treatment that you require to bring your forehead, brows and upper lids into balance might either then be a brow lift (as above) or an upper blepharoplasty or both.