Introduction  

Browplasty is a cosmetic surgical procedure whose goal is to remove excess skin and tissues and tighten the skin to rejuvenate and improve facial appearance. Excess skin and tissues result in sagging eyebrows. Therefore, browplasty is performed to elevate the skin on the forehead. The procedure improves a drooping eyebrow that can obscure vision, lessens wrinkles and deep furrows that make a person appear angry and older. Various types of brow lifts have been developed to minimize incisions and reduce scars.

Brow ptosis (descent of the brow and fat pads beneath) is related to advanced age but can appear in young patients with conditions that weaken forehead muscles such as:

  • Melanoma
  • Facial dystonia
  • Blepharospasm
  • Surgical trauma
  • Keratoacanthoma
  • Myasthenia gravis
  • Basal cell carcinoma
  • Myotonic dystrophy
  • Squamous cell carcinoma
  • Oculopharyngeal dystrophy
  • Facial nerve palsies

 

Also Known As

  • Brow lift
  • Forehead lift

 

Preparation & Expectation Before Surgery

The specialist plastic surgeon carefully examines a patient's age, sex, physical attributes, and expectations before planning surgery. The specialist will provide the patient with sufficient information, including the risks and benefits, to enable the patient to make an informed decision. 

A month before the procedure, a smoker must stop smoking because nicotine can cause a reaction with anesthesia and slow down the healing process. 

The patient should also avoid the following:

  • Alcohol
     
  • Hair dye
     
  • Blood thinners such as aspirin
     
  • Food and drink at least six hours before surgery


 Types, Purpose & Procedure

The goal of a brow lift is to rejuvenate the upper face and improve aesthetics with minimal complications. There are various types of browplasty which include:

  • Coronal brow lift - The surgeon makes a long incision in the area of the scalp hidden by hair. S/he tries to prevent the hair follicles from damage by bevelling the incision site. The incision site is long as it runs across the top of the head from one ear to another.The surgeon then manually lifts the brow together with underlying muscles. S/he removes excess skin to create a refreshed, smoother forehead.
     
  • Endoscopic brow lift - The surgeon makes 4-6 tiny incisions behind the hairline within the scalp. S/he inserts an endoscope with an attached camera to view muscles and tissue. The surgeon extracts extraneous fat and tissue and moves and cuts the muscles in a way that lifts the brow. Fewer scars result from this procedure compared to the traditional browplasty with long incisions. It is the most popular type because the recovery time is shorter as well.
     
  • Pretrichial brow lift - The surgeon makes incisions along the hairline at the front. S/he selects the incision site based on the shape of the forehead and hairline. This procedure is preferred in patients with very curvy foreheads or high hairlines. It is often combined with an endoscopic forehead lift and the incisions are placed in a short central location.
     
  • Combination mid-brow incision with endoscopic brow lift - The surgeon makes an incision in a forehead crease. S/he then uses an endoscope to examine the tissue, fascia, and muscle in the brow area.
     
  • Traditional mid-brow lift - The surgeon makes an incision in the forehead crease. S/he removes excess skin and lifts the brow. This procedure enables the raising of flaps of skin to correct asymmetrical or crooked eyebrows to perfect the brow position.
     
  • Direct brow lift - The surgeon makes incisions directly on top of the eyebrow hairs to hide the scars. The procedure is said to help with brow height asymmetry because it can reverse drooping eyebrows. It also provides long-term results for patients with high hairlines and bald men. However, the procedure has the potential for scarring, so it’s not preferred. Older or male patients with thick, bushy eyebrows, nevertheless, opt for it because the eyebrows can hide the scars.
     
  • Chemical brow lift - The specialist uses chemical substances such as Botox and not incisions and sutures, to lift the eyebrows. S/he injects the substance into the area of interest to help relax the muscles that pull the brow downward. The patient ends up with minimal wrinkles. Sometimes specialists can combine Botox with dermal fillers to raise and shape the brow.

 

Risks, Side Effects & Complications

The risks and complications of this procedure vary according to the type of technique used. For example, with an endoscopic forehead lift, the patient may develop a higher hairline. 

A direct brow lift can cause excessive bleeding, infection, and unsightly scarring. 

Because it involves a long incision, coronal brow lift can lead to excessive bleeding. The process and recovery time take longer, and the hairline may also be elevated in coronal brow lift.

Generally, other risks and complications include:

  • Loss of skin
     
  • Persistent pain
     
  • Anesthesia risks
     
  • Facial asymmetry
     
  • Poor wound healing
     
  • Accumulation of fluid
     
  • Eye dryness or irritation 
     
  • Loss of hair around incisions
     
  • Scarring or unsightly scarring
     
  • Deep venous thrombosis (rare risk)
     
  • Intense itching or other skin sensation
     
  • Paralysis or facial nerve injury with weakness

 

After Care, Recovery & Results

The results of the surgery are usually immediately visible, although with swelling and pain. With time, the swelling will disappear, and the incision lines will refine and fade. The wound should take between 10 to 14 days to heal, and sutures will be removed when the specialist deems it fit. Those who have undergone chemical brow lift should avoid reclining for four hours following the procedure.

The patient must rigorously follow the specialist’s instructions for success. The instructions may include:

  • Follow-up details
     
  • Caring and draining of surgical site
     
  • Medications to be taken orally or applied on the site
     
  • Sources of concern concerning the surgical site or general health

 

Patients must avoid subjecting the incision site to excessive force during the healing period. They should keep the head elevated and avoid strenuous physical activities. Recovery time depends on the type of operation. Generally, it may take several months for complete recovery.