Brow Lift Surgery Toronto

Brow lift is the one procedure we occasionally need to ‘sell’ to our patients, as they often will not appreciate how important brow position is to the appearance of the upper eyelid. We offer several surgical procedures, modifying our technique to the specific needs of our patient.  A brow lift for a bald man is quite different from that for a young woman with paralysis of one side of the face.  Brow Lift or forehead lift surgery is our most powerful tool for people who complain that “they always look tired???.

Successful facial rejuvenation requires harmonious changes to both the lower and the upper face, and too often, the upper face is neglected creating an artificial and unbalanced appearance.  Moreover, people may perceive that the appearance of heavy, tired eyes is best solved by a blepharoplasty when really a brow lift is the solution. 

Benefits of A Brow Lift

Brow lift surgery can provide both cosmetic and functional benefits. Cosmetically it corrects for hooding that appears on the outer aspect of the brow that can create a sad or tired appearance. Removing this hooding will decrease the subconscious activity of raising your brow by contracting your forehead (frontalis muscle), and thus will diminish multiple skin creases that can appear across the forehead. This sagging of brow tissues, or ptosis can also cause obstructed visual field, and constantly trying to lift your brow can contribute to tension headaches. Brow lift has both cosmetic and functional benefits.

Are You A Candidate?

Many people are candidates for brow lifts and don’t even realize it. Often a facelift alone will create a younger lower face and neck appearance, but if the upper face is not lifted as well, the result is disharmony between the upper and lower face. If you are developing forehead creases or if you are experiencing nighttime headaches or if people are always telling you that you look sad or tired, a brow lift may be the right procedure for you. The operation is relatively quick and easy to recover from, and can be performed under sedation with local aesthetic, so even people who might not do well with complex surgical procedures may be candidates for a brow lift. Bruising is always a problem with any facial surgery and an allowance for up to two weeks of visible bruising should be made.

Options For Brow Lift

Coronal Brow Lift

Coronal brow lift is the most traditional technique for brow surgery, but is rarely done anymore. The incision which passes from ear to ear across the top of the scalp can be well hidden in someone with a full head of hair. It allows for powerful reshaping of the upper face, but indeed it is possible to overcorrect and create an artificial appearance with this technique. It is also a problem that the lift occurs behind the hairline and so results in the removal of hair bearing scalp and, elongation of the forehead, which is rare rarely an ideal cosmetic effect. 

Endoscopic Brow Lift

When endoscopic surgery became popular in the 70s and 80s through the advent of lighted telescopes, there was a rush to include this technology in the plastic surgery armamentarium. Many of us at that time learned to release the brow through five incisions across the scalp and then pull the scalp back with either sutures or bone anchors. Unfortunately, it was not uncommon for the tissues to relapse as the point of traction was so far back in the scalp and, there remained the tendancy for the intervening tissues to stretch, and to lose the effect of the brow lift. It also was compromised by the elevation of the hairline as similarly to the coronal lift the pull occurred from well behind the hairline. This procedure is no longer a popular option among surgeons.

Temporal/Lateral Brow Lift

This technique is now the most popular option for brow lift surgery. And incision is made curving along the hairline back into the temporal recess, leaving only a small amount of scar visible at the front of the hairline, which can be easily camouflaged with most hairstyles. The lift is performed in the plane above the muscle and is used to elevate the sagging forehead and brow skin. It does not displace the hair and if anything the tension between the forehead skin and the scalp pulls the hairline forward. Temporary sutures can be placed between the skin and the muscle to minimize the risk of bleeding under the skin, a potential complication with all facial surgery. This technique does not directly correct the position of the central brow and forehead, but usually there are secondary benefits in reduced forehead creases because the forehead no longer needs to be as active in lifting the brow and so the forehead creases will disappear as a secondary benefit. 

Endotine

It is technically possible to lift the brow up through an eyelid incision by placing an absorbable anchor into the skull above the brow, and hanging the brow tissues in an elevated position off this anchor.  Not surprisingly this can create a irregularities in the brow contour and provides limited opportunity for elevation. 

Thread Lift

Sutures, both temporary and permanent have been designed with cogs or hooks that would grab the tissues and could be used to pull the brow from an anchored position in the scalp into a higher position. Thread lift procedures are highly prone to loss of their effect as the soft tissues pull through these cogs or hooks much like a cheese through wire. 

Botox

It is a misconception that Botox placed across the forehead lifts the brows. In fact, by relaxing the forehead muscle, the frontalis, it generally will cause the brow to be positioned lower and is frequently faulted for people losing the ability to form expression with their eyes or creating a hooded lid appearance. Nevertheless, a small elevation can be obtained by placing botox just under the eyebrow along its lateral edge in the orbicularis oculi muscle. This muscle pulls the corner of the brow down, and by paralyzing this muscle some lift effect is obtained.  In general, this effect is quite subtle.

Direct Brow Lift

Direct brow lift is a very powerful technique for reshaping and lifting the brow. The incision is made directly above the brow and hides very well in people who already have visible forehead creases. This procedure can be performed easily under local aesthetic and has a quick recovery.

Risks and Limitations

Surgical procedures by definition involve incisions through the skin, but the temporal brow lift does the best job of placing the incision in an inconspicuous location mostly within the hairline. Nevertheless, if it’s anticipated that the patient will be experiencing recession of their hairline it must be anticipated that this scar could become visible overtime. 

Facial surgery, necessitates, some bruising, and swelling and so a period up to two weeks may be necessary before, you can easily socialize after this surgery.

If skin is pulled too tightly or there are existing problems with blood supply, for instance, in a smoker, there is a risk of ischemia and the skin around the sutures are dying. This will lengthen the period of healing and may result increased scarring in this area. 

Recovery from Brow lift surgery requires a period of about 10 days when you should avoid any exertion that could cause blood vessel to open up and bleed into the surgical site.  Sleeping in a head up position will also decrease swelling. It would be routine to resume normal physical activity by three weeks and full contact sports would be possible by six weeks.

Long-Term Issues

Brow lift surgery is generally quite durable, and it is uncommon to need a repeat procedure, unless it was not successful in the first place. Tissues need to be elevated and effectively hung higher on the forehead muscle to maintain the effect.  Simply pulling the skin tight does not provide a durable lift. This surgery is consistently one of the most popular procedures in cosmetic surgery.