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It is said that “The eyes are the windows to the soul.”  And indeed, the eyes and eyebrows do provide a glimpse into a person’s health, age, vitality and mental state.  How often can you tell if a person is happy/unhappy, tired or in pain if not in their eyes?  It is for these reasons that many women and men turn to eyelid and browlift surgery as their first foray into cosmetic surgery.

BACKGROUND

When considering eyelid surgery, however, one should first examine the eyebrows, for they have a mighty impact on the upper eyelids.  Proper position and shape of the brows is important, for both men and women.  On a woman, brows should be gently arched, with the inner portion slightly lower than the outer “tail.”  And the entire brow should be located at or slightly higher than the bone of the eyeball socket.  A man’s brow should be more horizontally oriented and located at or just below the bone of the eyeball socket.  Neither sex benefits from a brow that is too high, the so-called “surprised” look.  Yet, low placed brows, or brows that do not have a proper shape, can provide all the variations of the “happy face” diagram/emoticon that we are all familiar with. In essence, the position and shape of your brows can convey an impression, rightly or wrongly, to others who meet you for that critical “first impression.” Low placed brows will also contribute to the appearance of severe excess skin or hooding of the outer portion of the upper lids.

As one ages, there is a loss of collagen and elasticity in the skin, which results in a gradual descent of the brows, increased horizontal lines of the forehead, deep vertical lines between the eyebrows (the “worry” lines), distortion of the shape of the eyebrows themselves and excess skin or even “hooding” of the upper eyelids.  Excess sun exposure and smoking can hasten the aging process.

Properly performed browlift surgery can aid in re-shaping and re-positioning the brows to a more youthful, normal but not overly exaggerated position.  By doing so, the browlift can reduce the appearance of lines and wrinkles and provide a firmer and much more youthful appearance to the upper third of the face.  It can also take up some of the slack excess skin of the upper eyelids as well.

HOW IS THE OPERATION PERFORMED?

There are several acceptable variations for a browlift (or forehead lift) operation.  Which variation is best will be decided upon after examination and discussion with the patient.

Nose Surgery / Rhinoplasty in New YorkFor women, either a conventional (coronal) browlift or an endoscopic browlift is commonly chosen (see below for descriptions).  Men, often with receding or absent hairlines, may choose an endoscopic browlift or on occasion, a direct brow lift or a mid-forehead lift.  And sometimes, for either sex, just a temporal lift, which lifts up the tail of the brow, is the best choice.

CORONAL BROWLIFT

A coronal or conventional browlift, still considered the gold standard of browlifts, involves an incision across the scalp.  It is possible to lift the brows substantially upward with this procedure and it can also be used to create brow symmetry when one eyebrow is lower than the other. The incision can be made behind the hairline (in the scalp) or at the hairline, depending on need and preference.  If the patient has a high hairline, then the browlift can actually aid in lowering it; and if the hairline is too low, then varying the incision location of the browlift can actually raise the hairline.  Very rarely, an incision can be made in a horizontal crease line of the forehead itself.  This latter incision is more useful in men with deep forehead creases and minimal hair.

In all cases, the skin and eyebrows of the forehead are then gently elevated and lifted, excess tissues removed and some specific muscles may be deliberately weakened so as to minimize future wrinkling.  The incision is then sutured and appropriate gauze dressings are applied.

The resulting scars, whether at or behind the hairline, tend to heal extremely well – and are disguised by the hair itself.

ENDOSCOPIC BROWLIFT

This procedure is performed with multiple, smaller incisions at or within the hairline.  An endoscope instrument attached to a video camera is inserted through one incision and various surgical instruments inserted through the other incisions.  The skin is loosened and then lifted into the appropriate position. Delicate weakening of specific muscles can also be done to minimize future wrinkles. The forehead skin is usually supported in the uplifted position with a temporary internal device or suture which dissolves over time. No skin or excess tissues are removed and the main lifting occurs through spontaneous tightening of the skin itself. The incisions are sutured and gauze dressings are applied. 

Nose Surgery / Rhinoplasty in New YorkThis technique does not adequately address treatment of asymmetric eyebrows.  It can usually provide only a few millimeters of lift, at best, when evaluated one year after surgery.  It works best for those who require just a little bit of eyebrow elevation.

TEMPORAL LIFT

This procedure, useful for both men and women, is performed through a vertical incision in the scalp of the temple region.  Its main goal is to elevate the outer portion of the eyebrow and to aid in the treatment of the “hooding” of the outer portions of the upper eyelid skin.  It does not elevate the main body of the eyebrows.

DIRECT BROW LIFT

This rarely performed procedure is most often used for men and also for instances of severe asymmetry of the levels of the brows.  It requires an incision just above the hair of the eyebrows only.  An appropriately measured sliver of skin is removed just above the brow and the wound carefully sutured – this elevates the brow.  The operation works best for those with bushy eyebrows.

IN THE OPERATING ROOM

Nose Surgery / Rhinoplasty in New YorkAll of the above procedures are performed on an out-patient, ambulatory basis in our fully accredited (by The Joint Commission) office operating room suite. Most operations take from 60 – 90 minutes.  Safe, sedation anesthesia (“twilight sleep” not general anesthesia) is provided by our board-certified MD anesthesiologist.  You will be sleeping gently during the procedure, with no pain and no awareness.  And you will awaken gently, with no nausea, hangover, grogginess or sore throat.  You will then be taken to the recovery room for an hour or two and ultimately discharged in the care of another responsible adult.

AFTER SURGERY

After surgery, there will be some gauze dressings applied.  There may be a headache the first day after surgery, but after that there is usually no pain at all – just a feeling of tightness.  There may be some swelling and bruising of the forehead and around the eyes – these disappear rapidly.  Stitches or surgical clips are removed about one week after the operation.

In the longer term, there may be some numbness of the scalp and itching along the incisions – these do disappear over time. 

Most healing is accomplished in the first 3-4 weeks after surgery.  But there is continued healing which may take several more months.  You should be able to return to sedentary-type work within one week and to exercise within 3-4 weeks.

FREQUENTLY ASKED QUESTIONS

  1. WHAT AGE IS BEST TO HAVE THIS SURGERY?  There is no “best” age.  There are some teens and twenty-somethings that can benefit from a browlift.  For others, there is a gradual descent of the brows so that somewhere in the forty’s or fifty’s might be an appropriate time.  Bottom line:  you are ready for it when you are ready for it – age is not a factor.
  1. ARE THERE ANY EXERCISES WHICH COULD HELP TO AVOID SURGERY?  No, unfortunately no exercise or body position (ie standing on your head for a while) will be of help.  In fact, intense exercise of any facial muscles will only worsen any wrinkles you may have.
  1. WHAT IS THE DIFFERENCE BETWEEN A BROWLIFT AND A FOREHEAD LIFT?  They are both the same thing – just a different name.  Other terms used to describe this operation are:  foreheadplasty and eyebrow lift.
  1. CAN I GET A “PREVIEW” OF A BROWLIFT ON ME?  Yes you can!  Look in a mirror and very gently elevate the brows with your fingers.  If you like the difference, you might wish to consider this procedure.  Also, as you are lifting, look at the effect on the excess skin of the upper eyelids.  Oftentimes, a browlift may be all that is necessary to improve the excess skin of your upper eyelids.
  1. CAN A BROWLIFT BE COMBINED WITH OTHER FACIAL OPERATIONS SUCH AS A FACELIFT OR AN EYELID TUCK?  Absolutely yes – this is done all the time!  Each procedure will improve a particular part of the face – but they all complement one another. They can be performed separately or all at once – the end result, after all procedures are performed, will be the same. If a browlift is performed in conjunction with an upper and lower eyelid tuck, then the browlift should always be performed first.  Some of the upper eyelid skin will be improved by the browlift so that less skin need be removed from the upper eyelids.  The results of these combined procedures can be absolutely spectacular!
  1. CAN BOTOX PROVIDE A “NON-SURGICAL” BROWLIFT?  Botox injections, which must be repeated every four months in order to maintain the effects, can help to diminish the worry lines between the brows, soften the horizontal forehead lines and minimize the crow’s feet on the sides of the eyes.  Botox, however, cannot elevate or lift the main body of the brows at all.  In fact, if improperly injected into the forehead, it can allow the brows to droop somewhat.  The only exception is that a small Botox injection below the tail of the brow can provide a slight elevation of the tail only.  And another small Botox injection below the inner “head” of the brow can similarly raise it by a millimeter or so.
  1. CAN A BROWLIFT OR BOTOX HELP WITH MIGRAINE HEADACHES?  Botox injections into muscle trigger points have definitely been shown to help with migraines.  There have also been some studies which have demonstrated some improvement of migraines with browlift surgery – but the specifics are still being worked out.
  1. CAN A BROWLIFT BE PERFORMED IF I HAVE ALREADY HAD MY UPPER EYELIDS OPERATED UPON?  Possibly.  A browlift will always have an effect on the upper eyelids.  If the eyelids are already smooth and tight, then a browlift might possibly make it difficult for your eyelids to close completely at night – a definite no-no.  On the other hand, if there is still some lax skin on the upper eyelids, then a browlift -- done very carefully -- could be considered.  This is why, whenever both procedures are being considered, that the browlift be performed prior to or at the same time as the upper eyelid tuck.
  1. WILL A BROWLIFT AFFECT MY HAIR?  Sometimes there may be temporary thinning of the hair in front of the incision – but the hair usually grows back over time.  The hair behind the incision will not be affected at all.  You should have your hair cut and colored just before surgery – it will be one month before you can cut and color again.
  1. DOES INSURANCE COVER THIS OPERATION?  No, it does not – it is a cosmetic procedure.




Dr. Elliot Jacobs, M.D., Plastic Surgeon
815 Park Avenue
New York, New York 10021
Telephone (212) 570-6080

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