Project Description

Dr John Flood specialises in Brow Lift Surgery Sydney.  There are a number of techniques available to perform a brow lift.

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Open Brown Lift

Open brow lifting involves making an extended incision hidden within the hair-bearing scalp. The dissection is then performed onto the skull bone extending beneath the forehead skin and muscles down to the eyebrows. Removal or partial division of the muscles which cause frowning of the eyebrows can then be performed. At the same time partial removal or incisions of the frontalis muscle that cause the horizontal frown lines of the forehead can also be removed. The forehead flap is then elevated and redundant scalp skin can then be excised and the suture line stitched and hidden within the hair-bearing scalp.

This procedure can be performed as a day surgery procedure under general anaesthetic. Sutures are removed after 10 days. Most patients do complain of swelling and bruising around the eyes during this period of time. Return to work is usually at two weeks and return to heavy gym work three weeks.

The benefit of this procedure is that manipulation of the muscles under direct vision can be performed. Also, in patients who have redundant forehead and scalp tissue can be re-draped over a large plane and excised.

The disadvantage of this technique is that it requires a fairly extended incision. At times scar alopecia can occur. Post-operative recovery tends to be longer than other techniques. Another important complication that is associated with this technique is disaesthesia of the supraorbital and supratrochlear nerves leading to sensation of a persistent itchiness of the forehead. This has been reported in approximately 1 in 200 cases.

Endoscopic Brown Lift

Endoscopic brow lifting technique is an excellent technique to elevate the brows through minimal incisions in the hair bearing scalp. In the case of patient’s seeking eyelid rejuvenation (blepharoplasty), the effect of the brow on the upper eyelids should be assessed. Sagging (ptotic) eyebrows may give the appearance of drooping upper eyelids. At times patients who are undergoing an upper blepharoplasty may indeed benefit from a combined endoscopic brow lift. Indeed, at times, endoscopic brow lifting procedures alone may obviate the need for an upper blepharoplasty.

The use of an endoscope through key hole incisions has simplified and increased the safety of brow lifting procedures. A telescope is inserted through the incisions in the hair bearing scalp. Between three and five small incisions less than 1 cm in length are used hidden in the hair bearing scalp. The telescope and surgical instruments are inserted through these incisions to help elevate the forehead soft tissues from the underlying forehead bone. Divisional or partial removal of muscles that contribute to the frown lines can be performed as well. Following this technique the soft tissues are elevated at a higher position leading to an aesthetic improvement of the eyebrow position. Eyebrows can be elevated between 4-7 mm higher. Usually the inner eyebrow (medial) is not as elevated as much as the more outer (lateral) eyebrow. This helps to avoid a “startled” appearance, as well as to provide a pleasing vector to the eyebrow line leading to a more youthful look. Also elevation of the more outer aspect of the eyebrow helps with reducing the amount of skin that has to be excised at the time of a combined blepharoplasty.

Given that the procedure uses quite advanced instrumentation, the procedure needs to be performed in a hospital as a day surgery procedure. The operation is performed under general anaesthetic. The operation takes between 90-120 minutes to perform.

Compared to open brow lifting the recovery time is much quicker. Patients complain of discomfort usually in their incision lines for a period of 24 hours. Minor tightness and swelling of the forehead lasts for seven days. Patients can return to work ten days post-operatively and return to heavy gym activity three weeks post-operatively.

Importantly endoscopic brow lifting should be considered in all patients who are enquiring about an upper blepharoplasty. At times it is the poor position of the eyebrow (forehead tissues) that is contributing to the appearance of tiredness and the feeling of heaviness in one’s upper eyelids. Only after an appropriate assessment can the right advice be provided to the patient whether the patient requires an endoscopic brow lift alone, blepharoplasty alone, or a combined brow lift and blepharoplasty procedure.