Definition and Overview
Browplasty, also known as a forehead or brow lift, is a surgical procedure that aims to elevate, or "lift" a drooping brow. This procedure can be performed for either cosmetic or functional purposes as a drooping eyebrow can obstruct vision and make the a person look old.
There are different kinds of browplasty procedures, which are categorized based on the type of surgical technique used. These include:
- Endoscopic forehead lift – As the term implies, this technique uses a surgical endoscope, which is a thin, flexible tube inserted through the skin of the forehead through tiny incisions. This method is preferred by patients who want to significantly minimize scarring. In this procedure, the surgeon smoothes out the loosened skin to elevate the brow and eliminate deep worry lines. As this method uses tiny incisions, patients can expect minimal bleeding and faster recovery time.
- Direct brow lift – This is typically recommended for older and male patients with male pattern baldness and thick eyebrow hair. It involves the removal of a skin segment, as well as muscles, just above the eyebrow to eliminate the appearance of drooping eyebrow. The technique requires incisions that can result to prominent scars.
- Coronal forehead lift – This technique involves making incisions not on the face but from one ear to the other to elevate the whole brow and forehead. Although it does not result in visible scarring, the technique requires loosening a large portion of forehead tissue and skin to achieve the desired results. This means that it is much more invasive when compared to other techniques such as endoscopic forehead lift.
- Pretrichial brow lift - This is very similar to a coronal forehead lift, but the incision is made on the upper forehead, near the patient's hairline, instead of from ear to ear.
- Mid-forehead lift – This is often recommended for patients with deeper wrinkles in the brow, and with eyebrows that sag over the eyes, obstructing vision. It involves the removal of excess skin and fat, and in some severe cases, some of the muscles in the forehead.
- Endotine brow lift - This is similar to an endoscopic forehead lift but uses a patented forehead fixation device (implants) without using long incisions and sutures.
Who should undergo and expected results
Patients with brow ptosis, or the descent of the brow and the fat pads underneath it, are ideal patients for this procedure. Brow ptosis is often associated with advanced age, but younger patients suffering from conditions that weaken the muscles in the forehead can also be affected. These include:
- Facial nerve palsy, including Bell's palsy and acoustic neuroma
- Surgical trauma
- Myotonic dystrophy
- Myasthenia gravis
- Oculopharyngeal dystrophy
- Facial dystonias
- Basal and squamous cell carcinoma
The expected results of the procedure are improved appearance and vision.
How the procedure works
A browplasty procedure can involve different surgical techniques, but the basic principle remains the same: the surgeon makes incisions to loosen up the patient's skin and access the underlying tissues, muscles, or fat pads. Depending on the patient's unique circumstances, excess skin and underlying tissue can be removed or tighten before the remaining skin is smoothened out to eliminate the appearance of wrinkles. This outpatient procedure is typically performed under local anesthesia. Patients can expect swelling at least two days after the procedure but this can be resolved by using ice packs. Full recovery, on the other hand, can be expected within 10-14 days.
Possible risks and complications
Risks and complications of a brow lift often depend on the type of surgical technique used. These include:
- Endoscopic forehead lift. This often results in a higher hairline that some patients might not consider visually appealing.
- Direct brow lift. Just like other types of open surgical procedures, this can result in excessive bleeding, unsightly scarring, and infection.
Coronal forehead lift. This can also result in excessive bleeding since it involves a long incision from one ear to the other. The patient will also have to sit through a longer operation, and recovery time will not be as short as other minimally invasive brow lift procedures. The patient's hairline might also be elevated after the procedure.
Codere F, Tucker N. Cosmetic blepharoplasty, and browplasty. In: Yanoff M, Duker JS, eds. Ophthalmology. 3rd ed. St. Louis, Mo: Mosby Elsevier; 2008:chap 12.16.