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Brow or Forehead Lift

Drooping of the skin on the brows and of the eyebrows themselves can be due to loose skin and fat loss around the brow, forehead and temples. Age, sun damage, and furrowing your brow can also create horizontal wrinkles on the forehead and vertical frown lines in the glabella (the small area between the two eyebrows and above the nose). A brow lift, also called a forehead lift, can improve all these problems and give you a younger, more refreshed look. 

What Is a Brow Lift?

The brow lift is a cosmetic surgical procedure that raises the eyebrows and smoothes the forehead, resulting in a rejuvenate, more relaxed look. In almost all forms of brow lift, the skin of the forehead or forehead and temples or just the temples is loosened and redraped, and excess skin is removed before the incisions are closed. In some cases, the surgeon will also rearrange or shorten some of the muscles in thee forehead and brow area. 

There are several techniques for  a brow lift, including:

• Endoscopic Technique: This technique is done using small incisions and special tubes and fiber optic devices. The surgeon makes three to six incisions behind the hairline, where the scars will be hidden by hair growth. This type of brow lift is often used in younger individuals who may not need much rejuvenation.
• Endoscopic Technique with Suture Suspension: This procedure also done with endoscopic tubes, but also uses permanent sutures to suspend the muscles and tissue of the brow into a new position. The sutures hold the tissues in place by either passing through the muscles or by suspending the muscles from a special barb attached to the skull. With the endoscopic brow lifts, the results are subtler and more suitable for younger persons not wanting too much of a lift.
• Full Coronal Technique: This is the oldest type of brow lift. An incision is made from one temple to the other across the crown of the head. The skin and sometimes the muscles are pulled upward and redraped and excess skin is removed. The incision is hidden behind the hair line. This technique works very well, especially if a lot of skin must be removed and if furrows on the brow are very deep. However, it is a more extensive surgery. Another drawback is that a receding hairline can reveal the long incision.
• Subcutaneous Brow Lift: Incisions for this technique are made in front of the hairline, which means that the scars may be visible.
• Temporal Brow Lift: This is also called a lateral lift or lateral brow lift. Incisions are made at the temples behind the hairline. It can produce an exotic look to the outer arch of the brow or a cat look, which may or may not be your cup of tea. However, it can also deal with folds and small wrinkles in the forehead, the glabella, and corners of the eyes (crow’s feet).  A temporal lift can also lift the skin cheeks and can restore a more chiseled look to the cheekbones. This lift is considered a tension lift, which means the skin is stretched and under a bit of tension, which can cause stretched or widened scars.
• Temporal Brow Lift with Suture Suspension:  This is the same as the temporal lift, but it uses internal, permanent sutures to suspend the muscles and tissue.

There is an additional surgical procedure called corrugator excision or corrugator myectomy that can be done to stop the corrugator muscle of your forehead from furrowing your brow. However, Botox injections can stop this muscle from causing the furrows without the need for surgery, so this procedure is not done as frequently as it once was.

Although not every brow lift  involves moving, rearranging, or shortening the muscles under the skin, some brow lifts do. There are essentially three muscles in the forehead and brow area. They are:

• The corrugator: This muscle pulls the eyebrows to the center of the face and downward, forming vertical wrinkles in the glabella area and horizontal wrinkles at the bridge of the nose.
• The frontalis: This sheet-like muscle runs from the hairline straight down to the eyebrows. It draws the eyebrows and skin of the forehead up and forms horizontal wrinkles across the forehead. The inner (medial) and outer (lateral) parts can function relatively independently, which is why some people can raise one eyebrow or even just the outer corner of one eyebrow.
• The procerus: This muscle runs from the nasal bone and cartilage at the side of the nose and fans upward to the center of the forehead between the eyebrows. It pulls the skin of the center of the forehead down, forming transverse wrinkles in the glabella region and bridge of the nose.

Are You a Candidate for a Brow Lift?

First and foremost, your must be in good health and not have any uncontrolled diseases or medical conditions to be a candidate for any cosmetic procedure. You must also have realistic expectations of what a brow lift can do.  A brow lift can make you look younger and more relaxed. It cannot change any other factor about your life. It can rejuvenate your face a great deal, but it cannot make you look like you are 20 again.

Communication is crucial. You must be able sit down with the surgeon and clearly discuss what you want done if he or she is to help you achieve your desired results. Discuss your goals with your surgeon so that you can reach an understanding about what can realistically be achieved.

You must be emotionally stable before having any cosmetic procedure. You will need patience and stability to with the surgery and recovering from it.  Some people experience a let-down or depression after surgery. If you already have a pre-existing emotional problem, this low period can develop into a more serious issue. 

However, if you are healthy and emotionally stable and want to rid yourself superficial wrinkles on the forehead or raise those sagging, angry-looking eyebrows, you may be a good candidate for a brow lift.  If you have excessive sagging skin all over your face and below the brow, you might consider combining a brow lift with other cosmetic surgeries, as a Face Lift , Platysmaplasty (neck lift) , or Blepharoplasty.

If you just need a little help with your forehead and just a bit of rejuvenation, you can also consider less invasive procedures such as intense pulsed light therapy, Botox® Cosmetic, laser resurfacing, or a chemical peel.  These can also be done in conjunction with a brow lift.

What to Expect at Your Consultation

Collect the names of some good cosmetic surgeons in your area and then make a few consultation appointments. During a consultation appointment, you will meet with these surgeons and discuss your goals. The surgeon will examine your face and get a complete medical history from you.

You must disclose all information regarding your health.  You might want to sit and write up your medical history, including your family history, all serious diseases you have ever had and any past surgeries. Having it written in advance can help you organize it and can keep you from forgetting anything. Make sure that you tell the surgeon about any allergies you have ever had; any conditions such as asthma, high blood pressure, or diabetes; whether you smoke, and all medications you are taking. This includes vitamin or mineral supplements, herbal products, and over-the-counter medications.  Hold nothing back.

At the consultation, your surgeon will listen to you and discuss what he or she thinks needs to be done. The two of you will go over techniques and incision placements or methods for a brow lift that are most appropriate for you. You should discuss the risks associated with brow lift, as well. Things can go wrong even in the best of circumstances and you must be informed.

You will also discuss what anesthesia will be used for your procedure. Most brow lift procedures are performed under light sleep sedation or general anesthesia. You will also discuss who will administer the anesthesia, which ca be done by an anesthesiologist (a medical doctor), an anesthetist (a specially trained nurse or physician’s assistant), or by the surgeon. Either way, you must discuss this beforehand because there are risks with any anesthesia. You can read more at our Anesthesia Page, the risks regarding anesthesia should be considered for a fully informed choice. 

Another subject to discuss is where the surgery will take place. Brow lifts are usually done on an out-patient basis, which means that you go home that day. They can be performed in a hospital, in a freestanding surgical clinic, or in a surgical suite in the surgeon’s office.

You should discuss after care and postoperative visits with the surgeon, as well as the surgical fee, medication costs, and any other costs that may arise that are not covered by the surgeon’s fee, such as the anesthesiologist’s fee or hospital costs.  You can also discuss other procedures such a fat grafting, a chemical peel, or a face lift for greater rejuvenation.

Your surgeon’s office will probably have a portfolio of before-and-after photos of other patients. Although examples of other work are no guarantee of your own outcome, it can help you determine what your surgeon thinks is aesthetically pleasing. Make sure that the photos you look at are actually of your surgeon’s work and not just generic examples of what a brow lift can do. You can also ask for names of other patients whom you can speak with.        

If you would like more information on consultations, visit our Consultation Help Page.  If you book or reserve a surgery date, you will usually give a deposit to hold that date. This deposit is usually refundable if you cancel well in advance of the surgery, but may not be if you wait to the last minute to cancel.

Your Preoperative Appointment

The preoperative appointment will usually be schedule about a week or so ahead of your surgery. You can ask more questions and your surgeon will make certain you know what it realistically possible from a brow lift. You will also go over your preoperative instructions and recovery period instructions and learn about what to expect in the months ahead.

Do not hesitate to address any concerns you may have at this time. If you remember something when you get home or the next day or even the day of surgery, don't be afraid to ask.

Preparing for Your Brow Lift

You should be given a preoperative information packet that explains everything you should do and know before your surgery date. The packet should include a list of all the medications you must avoid taking for 1 to 2 weeks before your surgery. These medications will include, but are not limited to, products containing aspirin or ibuprofen. We have a list of medications and supplements here that should be avoided if possible before surgery. However, this list should not take the place of any instructions from your doctor. Make sure that both your surgeon and the anesthesiologist have a complete list of all medications and supplements that you take.

Usually, you will be asked to have blood tests done a week before your surgery. Blood tests check for blood sugar levels and levels of red and white blood cells and platelets, and are a basic check of your general health. You may also be asked to have a complete physical examination by a general physician if you have not had one in a long time.. If you are a woman, you may be asked to take a pregnancy test. These are an extra out-of-pocket expense

If you smoke, is very important to quit smoking as far in advance of your surgery as possible. Smoking interferes with circulation and healing. It can increase your risk of  tissue necrosis (tissue death), delayed healing, and other complications.

How this Procedure Is Performed

A brow lift normally takes an hour or two to perform, depending on the technique used. It can be done in conjunction with a face lift, eyelid surgery or other cosmetic surgery.

You will be hooked up to monitors to keep track of your blood pressure, heart rate, and blood oxygen levels. You may be given an oral sedative an hour or so before your surgery is scheduled to start.  Usually, you will have an intravenous (IV) line inserted into a vein in your arm or hand. This will be used to administer saline to keep you hydrated and to administer other drugs, if needed. At this point, anesthesia will be administered.

For a brow lift, the surgeon has to keep your hair out of the way. Your hair will either be gathered into sections with small rubber bands or clips, depending on what technique will be used. If a full coronal incision is to be make, your hair will be parted along where the incision will be so that as little hair as possible is lost. The same goes for other incisions that are to be hidden behind your hairline.

The surgeon will then make the incisions. Incision length and placement depends on the type of brow lift you are having. Your surgeon should make every effort to end up with inconspicuous scars.

Your surgeon will then dissect your skin and the muscles of your forehead. This means that he or she will loosen them from their attachments so that they can be moved and rearranged. He or she will then either remove excess, loose skin and possibly remove excess fat in the brow line. The muscles of the forehead may also be moved or rearranged. If suspensory sutures are being used, the surgeon may place a tiny attachment called a surgical barb in the skull to which the sutures will be attached.

The surgeon will then lift your brow skin to its new position and close the incision, usually with sutures or staples. Lastly, he or she will then apply a dressing to your face and head to protect the incisions, keep the tissue in the proper place during recovery, and put some pressure on the area to reduce swelling. This dressing may run from around the top of your head to under your chin.

After you are awakened, you will be and brought into the recovery room where you will be monitored until you are ready to be released, usually in two or more hours. Your forehead and scalp may feel tight, hot, and sore as the anesthesia wears off.  You can ask for a pain reliever. As you recover from anesthesia, you may feel very cold or emotional and upset. These are normal reactions. If you are cold, ask for a warm blanket. You may also feel nauseated. If you do, alert the staff.

After you are released, you must be driven home by your spouse or an adult friend or relative. You will not be allowed to drive yourself home.

The Road to Recovery

The first night after your surgery you may be groggy from the anesthetic and/or oral medications. You might not remember much of the first day or two.  You should take it easy for the first 7 to 14 days, or however long your surgeon suggests. 

You will be instructed to keep your head elevated for several days. Sleep with your head on two to three medium-sized pillows. 

Take your temperature regularly.  An elevated temperature could mean an infection. Take your antibiotics on time and do not skip any doses or stop taking them early.

You will usually be told to use cold compresses on your head and face to keep swelling and bruising to a minimum. Any pain should be alleviated by your prescribed pain medication, but if you have excessive pain, redness, pus or other symptoms that do not appear normal, contact your surgeon immediately.

Your forehead will look even swollen the first few days after surgery. As the days pass, the swelling will dissipate. There may be a lot of bruising, and possibly even two black eyes, but this will go away, as well. Bruising and swelling are normal and part of the natural healing process.

Your first postoperative visit may be as soon as the day after your surgery. The surgeon may change your bandages or may wait until the end of the week.  Your sutures won't be removed until 5 to 7 days after surgery. Any staples in your scalp may not come out until around day 10. 

Your scalp will be numb. This is normal; remember your nerves have been partially separated from their source. Give them time to recuperate. Take it easy but do getup and walk around a few times a day in the days after your surgery. This is good for you.

Even though you may feel better, you must take it easy for the first 3 weeks.  Be careful not to bend over or lift heavy objects, anything over 15 pounds or so. Your doctor may say don’t lift anything over 10 pounds. Do not participate in contact sports for at least 6 weeks, although you need to ask your surgeon what he or she recommends specifically.

Continue to avoid alcohol and anything with aspirin or ibuprofen until your surgeon says otherwise. If you smoked before the procedure, try not to start again. Smoking greatly impairs circulation and promoting poor healing and excessive scarring. Quit beforehand and stay off it. 

You will notice some odd sensations of tightness, tingling, a sporadic sharp pain, or pulling, burning, and cold sensations on your forehead. These usually subside within the first few weeks. As swelling subsides, you will see a more youthful appearance. This may take some time so prepare yourself emotionally. You may find that you may begin to feel sad or are depressed during your recovery.  Although this is rare, it does happen. It can stem from the lack of activity, medications, or the natural period of let down postoperatively.  See our Postoperative Depression Section for more information. 

Risks and Complications of Brow Lift

No surgery is without risks or is completely safe, including a brow lift. There are inherent risks with anesthesia and complications because of it, such as allergic reactions. You could also develop a hematoma (pocket of clotted or unclotted blood), seroma (pocket of fluid), infection, nerve damage, and lose skin or muscles due to poor circulation. Your forehead, eyebrows, or eyes may look asymmetrical.

A very common aftereffect with certain types of brow lift is alopecia—hair loss—along the incision lines or loss of hair elsewhere on the head or facial hair, including eyelashes or eyebrows. Usually, this hair loss is temporary. Only about 1% of alopecia cases become permanent.

You may end up with a higher hairline with the coronal lift technique, something you didn’t want. There is also a risk of failure, with the brow returning to its previous sagging position. This is rare, but more likely with endoscopic brow lifts, so consider this before committing to a procedure.  The risk of brow asymmetry is a reality. The skill of the surgeon is a factor here, but so is the variation in healing. One side of your face may heal before the other, and the asymmetry will resolve itself with time. If it doesn’t, you can have a minor touch up that can be performed with local or regional anesthesia in the office. 

The Average Prices for a Brow Lift

The cost for a brow lift is usually between $3,000 and $7,000, depending on technique and the area of the country. These prices usually include anesthesia and the surgeon's fee.