A brow lift, also known as a forehead lift or browplasty, is a cosmetic surgery procedure that aims to lift the eyebrows and smooth forehead wrinkles. It can help achieve a more youthful and refreshed facial appearance by raising sagging eyebrows and reducing frown lines between the eyebrows.
One of the most common concerns people have about brow lift surgery is whether it will leave a visible scar. Understanding the surgical techniques used and scar placement can help determine the potential for visible scarring after a brow lift.
How is a brow lift performed?
There are a few different surgical techniques that can be used to perform a brow lift:
Coronal brow lift
This technique involves making an incision from ear to ear across the top of the head within the hairline. The surgeon lifts up the forehead skin and tightens the muscles and tissues underneath. Coronal brow lift results in the most significant eyebrow elevation but leaves a potentially visible scar along the hairline.
Endoscopic brow lift
The endoscopic brow lift is a less invasive technique that utilizes an endoscope, a small camera inserted via small incisions in the hairline. The endoscope allows the surgeon to see under the skin and reposition the tissues without a long coronal incision. This results in a hidden scar in the hairline.
Temporal brow lift
Temporal brow lifts involve making incisions in the hair-bearing temporal region, above and lateral to the outer corners of the eyes. This lifts and mobilizes the outer brow subtly and leads to shorter, better hidden scars.
Direct brow lift
This minimally invasive approach involves making a small incision right under the brow. The brow tissue is repositioned and secured with sutures or anchors placed through the eyelid. There are no visible scars, but the results may be less dramatic.
Factors affecting brow lift scarring
Several factors impact the degree of visible scarring after a brow lift:
Surgical technique
The surgical approach used affects scar placement and visibility. Coronal brow lifts lead to the most visible, long scars along the hairline. Temporal and endoscopic lifts result in shorter scars hidden in the hairline. Direct brow lifts do not lead to any external scars.
Incision placement
Proper incision placement in the hairline can camouflage scars after a coronal or temporal brow lift. Lower incisions or uneven hairline can increase scar visibility. Men with receding hairlines may not be good candidates.
Hair density
Individuals with thick hair density usually experience better scar concealment than those with thin or fine hair. A sparse hairline may make scars more visible.
Skin elasticity
Younger skin with good elasticity typically heals with thinner, nearly invisible scars. Older skin tends to scar more noticeably.
Wound healing
Genetics affects how well and how quickly a person’s body heals from wounds. Scarring issues like keloid scars can lead to thicker, more visible scars. Adhering to post-op care instructions minimizes scarring.
Surgeon skill
An experienced, skilled surgeon will create clean incisions with meticulous wound closure using techniques to optimize hairline alignment. This improves scar concealment.
Scar appearance over time
Brow lift scars tend to fade and improve in appearance over time:
Early healing
Scars may be pink or red for the first few months after surgery as the incision site heals. Swelling can make the scar appear thicker initially.
3-6 months
Scar redness begins to subside. Swelling dissipates making the scar appear thinner.
1-2 years
Scars continue to fade in color over the next year or two. They typically become barely detectable thin white lines camouflaged in the hairline.
Proper scar care and sun protection helps maintain the long-term aesthetic appearance of brow lift scars.
Risk of visible scarring
The risk of significant visible scarring depends on the technique used:
Coronal brow lift
This has the highest risk of visible scarring with a long incision across the scalp. Up to 30% of patients may have a detectable scar.
Temporal brow lift
Shorter incisions have a lower risk of noticeable scarring in about 10-15% cases.
Endoscopic brow lift
This has the lowest risk of visible scarring, around 5%, as incisions are tiny and hidden.
Direct brow lift
No visible scars result from this technique. There is only an intra-lid scar concealed in the eyelid crease.
Can scars be revised?
In cases where a brow lift scar is uncomfortably visible, revision surgery may be an option to improve the scar’s appearance. This involves:
Excising the thick, raised scar
The visible scar tissue can be surgically removed and the incision closed with finer sutures.
Dermabrasion
Controlled surgical scraping (dermabrasion) of the scar smooths and thins the scar tissue.
Laser resurfacing
Laser therapy can be used to minimize and improve the appearance of scars.
Steroid injections
Injecting steroids like Kenalog into thick, red scars can flatten and soften them.
Silicone gel sheeting
Applying silicone sheets over healed incisions for 6-12 months can effectively flatten and fade scars.
Risks and complications
While rare in experienced hands, a brow lift carries possible risks like:
Infection
Antibiotics minimize infection risk. Signs include redness, swelling, oozing, and fever.
Bleeding and hematoma
This can cause painful swelling under the wound. Additional surgery may be required to drain it.
Skin sensory changes
Some loss of forehead sensation is common but usually temporary as nerves heal.
Hair loss
Hair follicles damaged at the incision site can cause temporary localized hair loss along the scars.
Asymmetry
Slight unevenness between left and right brow height is possible. A revision surgery can correct asymmetry.
Recurrent brow ptosis
The brows may gradually re-droop due to skin laxity and gravity. A browpexy procedure creates a lifting effect.
Scarring issues
Abnormal scarring like hypertrophic scars and keloids may require additional treatment and scar revision.
Ideal brow lift candidates
The best candidates for a brow lift are:
– Adults with sagging brows and forehead skin creating an ‘angry’, ‘tired’, or ‘sad’ facial expression
– Individuals bothered by horizontal forehead creases and frown lines between the brows
– People with good skin elasticity and healing ability
– Healthy individuals not prone to keloid scarring
– Those with realistic expectations of the procedure and results
– Non-smokers
– Individuals willing to follow pre and post-op instructions
Preparing for brow lift surgery
Preparing properly prior to brow lift surgery can support optimal results and minimize risks like visible scarring:
– Discontinue blood-thinning medications like aspirin, NSAIDs, and certain supplements 1-2 weeks before surgery based on the surgeon’s instructions. These increase bleeding risks during surgery.
– Quit smoking at least 6 weeks before the procedure. Smoking impedes blood flow, slowing healing and leading to thicker scars.
– Avoid alcohol for 48 hours pre-surgery as it dehydrates the body and can increase bleeding risks.
– Set up transportation and assistance during the initial recovery period when movement is restricted.
– Arrange for time off of work or other obligations to rest and heal properly after surgery.
– Follow the surgeon’s pre-operative orders for fasting, medication, and preparing the home.
– Make sure to realistically communicate aesthetic goals and concerns about visible scarring to the surgeon.
Brow lift recovery
Recovery after brow lift surgery is important for minimizing scarring:
Bandages and dressings
Facial dressings, bandages, and drainage tubes are removed within 2-5 days post-surgery. The scalp may remain wrapped for a longer period.
Head elevation
Keep the head elevated on 2-3 pillows for the first week to minimize swelling that can put pressure on the incisions.
Cold compresses
Gently applying cold compresses helps soothe surgical sites and reduce swelling.
Sleeping position
Sleep on the back or side, keeping the head elevated for 1-2 weeks after brow lift surgery. Avoid rolling over onto the face.
Strenuous activity
Activities like bending over, lifting, and straining should be avoided for at least 2 weeks post-op to prevent wound tension.
Sun exposure
Direct sun exposure should be avoided for 3-6 months after surgery to minimize scarring. Wear wide brim hats and high SPF sunscreen.
Following proper wound care and scar management techniques specified by the surgeon optimizes healing.
Conclusion
While some degree of scarring is inevitable after a brow lift procedure, the risk of significant visible scarring is relatively low with endoscopic and temporal techniques properly performed by an experienced, qualified surgeon. Taking steps to prepare for surgery optimally, follow post-operative instructions diligently, care for scars properly, and protect them from sun damage can help achieve well-concealed scars and an improved brow position.