The eyes are the most expressive part of the human face and they are framed by the eyebrows. Therefore, the upper lids and eyebrows form a complex which should be considered together; surgery on one will always affect the appearance and function of the other.
As we age, the shape of our eyebrows changes, with the typical person noticing the corner of the eye "closing in" as the lateral (outside edge) of the brow drops. Paradoxically, eyebrows sometimes appear to be higher, especially in the portion approaching the nose, possibly due to the chronic muscle action of raising the eyebrows.
Since the introduction of botulinum toxin type A, a simpler way to change eyebrow shape and position has become popular, reducing the requirement for brow lifting in many patients. Nevertheless, many people can benefit from surgical lifting and reshaping of the eyebrows. This procedure can be performed through a number of different approaches – the "open coronal" approach, the "endoscopic" approach, the short incision approach, and even through an upper eyelid incision. There are advantages and disadvantages to any of these methods, which ideally should be customized for the individual patient.
If you are considering surgery, you can request a consultation with Richard J. Warren, MD. A staff member will contact you to discuss the procedure, Dr. Warren's availability, and additional scheduling information.
Frequently Asked Questions
Your brow lift procedure is performed at the Vancouver Plastic Surgery Center, under a light anesthetic administered by a certified anesthesiologist.
For the typical cases where the lateral brow needs lifting, a short incision is made in the hair of the upper temple and, using an endoscope, the scalp is released from its attachment to the bone around the eye. The scalp is then lifted and held in place with stitches. If frown lines are a problem, the endoscope can also be used to alter frown muscles.
When the procedure is complete, a dressing is put in place, long lasting local anesthetic is injected, and the patient can begin recovery.
In the past, surgeons feared losing the effect of an elevated brow, so, for a long time, they tended to over-elevate the eyebrows. Typically, this problem is most obvious in the medial portion of the brow (beside the nose), which gives a person a surprised look. Because of this we have learned to be very conservative in the medial portion of the brow and to concentrate more on the lateral portion.
After the surgery, you will notice that your head is wrapped in a light dressing and your scalp may be numb due to the injection of local anaesthetic. Pain will likely be minimal. You will be kept in the recovery room for about 2 to 3 hours before you can be discharged home. You can expect to develop black eyes and swelling around the eyes which tends to get worse for 24 to 36 hours before it gets better. You will be given specific instructions about how to care for your incisions, what your activity level can be and when you may shower. We will speak to you by phone the following day.
The dressing is removed and you can shower and wash your hair by 5 days post op. The stitches are removed by 7 days. Initially people notice a tight feeling in their forehead and numbness on the top of the head. These conditions slowly resolve on their own. The feeling in the scalp can take up to 6 months to return completely. Bruising around the eyes usually resolves in 10 to 14 days.
It is impossible to cut through the skin and not leave a scar behind. However, the short scars now used for brow lifting are mostly invisible. Scarring can develop if hair is lost along the incision line, athough this can be corrected with a minor surgical revision.
Side effects – things which are expected to occur – include bruising, swelling, numbness of the scalp and a minor alteration in the scalp hairline. These symptoms all subside on their own. Medical complications are uncommon, with the most common problem being a hematoma – where blood collects under the scalp flap and requires drainage.