A decline in natural collagen levels as we age means that the skin on the forehead and around the eyelids becomes lax, and begins to droop – which creates a heavy brow, and can give the impression of constant tiredness. Browlifting surgery seeks to reposition the brow higher on the face (just above the orbital rim). For best and most natural looking results, browlift surgery should be performed prior to upper eyelid surgery.
There are a number of effective techniques to perform a brow lift. Traditionally, incisions would either be made across the top of the head from ear to ear (which is known as a coronal technique); directly above the eyebrow or in the hairline.
Although there are newer techniques that have been introduced in the years since, sometimes more traditional forms of surgery are required in order to produce more natural looking or effective results. This is particularly true for patients who have high hairlines in order to manage the brow and forehead area, and also for patients who are candidates for female feminisation surgery.
More recently, endoscopic techniques have become popular and have revolutionised the brow lift process, particularly because these techniques have made scarring less of an issue for prospective patients. During an endoscopic browlift, a series of tiny incisions are made around the hairline and within the hair-bearing part of the head (meaning that scarring can be easily concealed). The head does not have to be shaved for this. A small camera is used to allow the surgeon to safely dissect the forehead skin, elevating it from the underlying bone. After this, the eyebrows can be repositioned. The elevated level of the eyebrows and forehead must be held in place to sustain the lift, which can be done in a number of ways. More traditionally, screws (which will either be resorbable or made of titanium) are used, but an endotine – a newer device that has a number of small hooks that the tissue can ‘grab’ onto – can also be used.
You will be required to wear a head dressing, as well as a small drain in the immediate interim of your surgery, but these will be removed the day after your procedure. It is likely that you will have a headache postoperatively, although due to the local anaesthetic, your forehead will also probably feel numb.
You’ll be required to stay in hospital overnight, after which point you will be discharged, but should take time to rest before you resume your usual daily activities.
For the first 2-4 days after surgery, you should expect a routine amount of swelling and bruising, which should begin to subside after this time. It’s also normal for patients to experience swelling of the upper and lower eyelids; applying cold compresses to the area may help to reduce this and to avoid excess bruising. In the first few days postoperatively, you should keep the head elevated where possible – try sleeping on 2-3 pillows to reduce swelling. In most cases, it takes around 10-14 days for swelling to completely settle.