Open Brow Lift

An open brow lift is a lift that involves a single continuous incision that starts at ear level and goes upward and around the hairline. The surgeon makes the incision up in the hairline as opposed to just being above the eyebrows. This is different from an endoscopic brow lift where the surgeon makes a number of shorter incisions and performs the lift with the help of an endoscope through one of the incisions.

OPEN BROW PROCEDURE

An open brow lift is another way of saying coronal incision or coronoplasty.  The surgeon makes the incision either just in front of the hairline or just behind the hairline. The surgeon then makes a curvy transverse incision across the top of the forehead.  The incision in front or behind the hairline depends on where the hairline is located. Most men do not want to make the incision above the hairline because they do not want their hairline to be any higher than it already is.

Women who have a low hairline to begin with are not usually in danger of losing their hair as they age. This is why the doctor can make the incision behind the hairline. The advantage is there is really no visible scar because it is within the scalp and the hair bearing skin.

Making the incision in front of the hairline means the surgeon will not be elevating the hairline, but there will be a visible scar.

IDEAL CANDIDATE

Anybody in good health between the ages of 30 and 90 who has a low position of their eyebrows is an ideal candidate. For men, that can mean anything below the orbital rim. For women, it is anything at the orbital rim or lower. For example, patients who have heavy and droopy upper eyelids can get the low position of the brow corrected which corrects the eyelid at the same time. This elevates the eyebrow while also opening up the orbital region and removing the heavy lidded look from the upper eyes.

ENDOSCOPIC APPROACH 

The endoscopic approach used to be a popular choice for a brow lift. However, it was discovered that the results were only good for 3-6 months before the tissue would begin to droop again. Doing an endoscopic lift meant there had to be an anchoring of the tissue in the higher position with either a permanent anchor like a titanium screw or a semi-permanent absorbable material with little barbs on it. The lack of permanent results and the fact that patients could feel the barbs are the main reasons more people prefer an open brow lift. The results last longer than using the endoscopic brow lift technique.

The endoscopic brow lift has less scarring because there are small little incisions up within the hairline and not within the scalp. There is not usually a visible scar and that is the advantage.  Measuring that advantage against the disadvantage of chronic or long-term pain, hardware beneath the skin and short-lasting results, most patients choose to do an open brow lift.

ALTERNATIVE TREATMENTS

In terms of alternative non-surgical treatments, a patient is not going to get as significant a lift with any other procedure. An open brow lift actually removes skin and then lifts the brow and re-suspends it in a higher position so the results are immediate and long-lasting

Other procedures might have a better design to achieve a similar purpose of lifting the position of the brow on the forehead. For example, SmartLipo Laser can get some minor elevation of the brow tissue. The brow cannot be lifted as high so the results are not as effective. It is an alternate option that still involves making an incision and putting instruments underneath the skin.

LIMITATIONS

While it is not really a limitation, surgeons do need to be careful about not lifting the brow too high. When the brow is lifted too high, it tends to produce a look of surprise on the face of the patient. The patient will look startled all the time.

A real limitation is that there is a limit to the amount of the upper eyelid skin that can be reduced or tightened or eliminated with the brow lift. Some people require both operations to fully correct their eyelids. If the eyelid is the problem, the patient needs to think about doing the brow lift first. Doing the eyelids first and then the brow lift six months or a year later means the brow lift cannot be done if the eyelids have been overcorrected. Sequentially, the brow lift is the first operation and then, if necessary, the eyelids can be done.

SIDE EFFECTS

Most of the side effects are short term such as minimal post-operative pain, a week of bruising and two weeks of swelling. However, patients will be able to see just fine. It is very common to have numbness at the top of the head with this procedure because the surgeon cuts the nerves that provide sensation. The very top of the skull is going to be a little bit numb until the nerves have a chance to grow back. Sometimes the numbness is permanent and sometimes the sensation can return in two weeks. Unfortunately, the doctor will not know if the numbness is permanent until the sensation does or does not return.

RECOVERY

There will be some pain, bruising, and swelling but some patients can return to work the next day depending on their job. A person who works at home on the computer can go back to work the next day. It is about two weeks before the swelling is gone.

It takes several months for the scar to fade but it can be covered up by a hairstyle choice. Wearing a hat can help cover the scar for people who wear their hair completely pulled back or do not have bangs.

RESULTS

The results last until the end of the operation. Immediately after the surgery, the aging process continues and gravity continues to pull things. There is no such thing as permanent results but the open brow lift turns the clock back 10 or 20 years in terms of the brow and the peri-orbital region. In that sense, the results are permanent because it provides a permanent improvement in terms of the way the face looks as far as the aging process goes.

FINAL THOUGHTS

An open brow lift is a popular procedure. For people that have difficulty seeing because their eyelids are hanging down, it can be a very productive operation. It can also help reduce the symptoms and problems of people who suffer from fatigue or headaches because of eyelid strain. These are good medical reasons to have the procedure besides simple cosmetic or aesthetic aspects.

Written by Cosmetic Town Editorial Team - MA

Based on an exclusive interview with Trenton Jones, MD in Orem, UT