What is a brow lift or browpexy?

One of the problems of longstanding facial paralysis is drooping or descent of the forehead and brow. A brow lift (or forehead lift) will resuspend the forehead in a more natural and symmetric position.  A browpexy is similar in goal to the browlift; however, the technique is different.

The procedures are relatively straightforward and are often combined with other facial procedures such as facelift, eyelid surgery, neck lift, or facial fat grafting. A highly focused consultation is necessary to understand and individualize the results to each patient’s goals.

 

How is a brow lift or browpexy performed?

Various techniques for lifting the brow currently exist. Frequently, this will include an endoscopic approach, where a small thin camera is used through several small scalp incisions to visualize the area of the forehead. The muscles and tissues underneath the skin are then manipulated and elevated to the desired position where they are anchored. An alternative technique will achieve the same type of elevation through a slightly longer incision within the hair bearing scalp but under direct vision. Each of these approaches has its advantages.

Diagram of endoscopic brow lift to raise the forehead.

A browpexy elevates the brow more directly without extensive dissection of the forehead and scalp.  An elliptical incision is placed over the eyebrow requiring elevation.  The intervening skin is excised and the deep tissue of the eyebrow is anchored in an elevated position with strong sutures.  The amount of skin to be excised is determined prior to surgery with the patient in the upright position.  The eyebrow incision is then closed.

Diagram of browpexy technique in facial paralysis.

What is the recovery from browlift or browpexy?

Following surgery, the head is wrapped with loose bulky dressings to minimize bruising and swelling. Infrequently, a small thin tube may be used to release some of the underlying fluid accumulation. This is typically taken out within 24 hours in the doctor’s office. At this point, patients are allowed to shower with shampoo and water. Care is taken not to rub on the forehead or the areas of the incisions within the scalp. Much of the general activity restrictions and return to work instructions are similar to having had a facelift (hyperlink), including avoidance of strenuous activities, exercise, and heavy lifting. Most patients return to work 7 to 14 days following surgery. Pain medication is prescribed ahead of time. Antibiotics may also be used occasionally. Makeup is allowed to conceal any bruising, if it persists. The incisions themselves may sometimes be numb or maintain increased sensitivity for several weeks.

 

What are the risks and complications of browlift or browpexy?

In men, the eyebrow typically sits at the level of the lowest part of the forehead bone above the eyes. In women, the eyebrow tends to curve upwards slightly above this bone. One of the complications of a brow lift is related to overcorrection, giving an unusual surprised appearance to a woman or a feminizing appearance to a man. An experienced plastic surgeon recognizes this possibility and will pay special attention to positioning the brow at the time of surgery.

Additional risks include the possibility of blood accumulating underneath the skin (hematoma), infection, widened scar, nerve injury to muscles that move the eyebrows and wrinkle the forehead, and mild hair loss along the incisions. Additionally, there may be a need to abandon an endoscopic approach and switch to an open incision technique in rare cases.

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