What is a Brow lift?

Brow lift surgery at HouseMD Plastics is designed to correct drooping eyebrows and enhance the appearance of the forehead, brow, and upper eyelid. This surgical procedure rejuvenates the upper face, creating a more youthful and alert appearance.

What are the benefits and expected results?

It can be used to correct drooping eyebrows, forehead creases, and hooding of the upper eyelids, particularly the lateral or outer eyelids. 

In women, the eyebrow typically sits above the ridge of bone that makes up the top of the eye socket, known as the orbital rim. Also, the apex of the brow typically arches above the outer part of the eyelashes (lateral limbus), but some patients may prefer an arch slightly past this (more lateral). The average height of the brow from the eyebrow to hairline is typically between 5 and 6 cm. Forehead heights greater than 7 cm may be aesthetically improved with forehead shortening maneuvers, such as a hairline advancement.

In men, the eyebrow typically sits at about the level of the orbital rim, which is slightly lower than in women. It is also less arched and more horizontally shaped. 

How is a Browlift performed?

The browlift is typically performed using one of two methods: the endoscopic browlift or the open browlift. In an endoscopic browlift, small incisions are made in the hairline and a thin, lighted tube called an endoscope is inserted. The endoscope is used to guide the surgeon as he or she makes small adjustments to the deep tissues of the forehead.

In an open browlift, a single, longer incision is made across the top of the forehead, just above the hairline, or in a prominent forehead crease (usually only done in older men). The skin and soft tissues are then lifted and adjusted.

Both methods of browlift are typically performed under IV or oral sedation with local injected anesthetic. The procedure takes about one to two hours to complete. After a browlift, the incisions are closed with sutures or surgical clips. These will be removed within 7-10 days.

There are several things to consider when deciding to proceed with a browlift, and specifically what time of browlift:

• The height of the native brow skin from the eyebrows to hairline. If it is exceptionally tall, a hairline advancement may be indicated.
• Hair quality — if the hair is quite thin or balding, certain techniques may be indicated over others. Be sure to tell your surgeon if you have had any hair transplantation procedures in the past, since this may dictate the position of the planned incisions. 
• Eyebrow aesthetics — shape, symmetry, quality, position, and mobility. If one side is higher than the other, or if only the outer (lateral/temporal) portion of the eyebrow has dropped (called ptosis), the browlifting technique is typically altered.
  
  History of dry eyes, prior eye surgery or blepharoplasty, and thyroid disorders. These conditions are always important to discuss with your surgeon, and may require medical clearance for surgery by your ophthalmologist.

What is the expected recovery?

Every patient is different, and every surgeon manages postoperative care differently. Typically, there some bruising and swelling after the procedure, but this should subside within 10-14 days. Most people are able to return to work and other normal activities after two weeks. However, it is important to avoid strenuous activity and exposure to the sun for at least six weeks to allow the incisions to heal properly.

Some points to consider during your recovery:

• The incisions for this procedure are in the scalp hidden by your hair. No hair is shaved.
• Ice compresses may be useful if you see bruising around the eyes for the first 48 hours
• Rest in bed with your head elevated on 2-3 pillows for the first 2 weeks
• Some oozing from the incisions is normal for the first 48 hours
• It is normal to be drowsy, but try and eat a light meal the evening following surgery
• If there is excessive bleeding, discoloration, swelling or sudden or severe pain, call your surgeon

Why should you choose Dr. House?

Dr. House has a passion for brow and eyelid surgery. He believes, as most, that the eyes are the windows to our soul. Saggy brows can give the appearance of being mad, sad, or tired, and being able to refresh the eye-region and give a more youthful appearance can give a significant, yet natural, improvement to one’s appearance. While completing a competitive surgical residency in head and neck surgery at UCSF, Dr. House published in peer-reviewed journals on browlift and hairline advancement techniques. He then went on to receive world-class training in Beverly Hills under Dr. Guy Massry, board-certified oculoplastic surgeon considered in the medical community as a leading expert in the field of Oculoplastic & Reconstructive Surgery.

Dr. House also cares deeply about his patients. This is why every patient receives detailed printed instructions that are personally reviewed with you by Dr. House at your preoperative appointment. In addition to the availability of his excellent office staff, he also gives his personal cell phone number out to all of his surgical patients because he believes that you should have access to him 24/7 for any concerns. You will hear him tell you that he treats his patients like family, and believes every patient should feel cared for as an individual rather than a number.

Dr. House combines this compassion with a natural eye and brings techniques from some of the best surgeons in the world home to the San Francisco Bay Area to give you cutting edge, peer-reviewed, and time-tested methods for the results you deserve. 

Postoperative Instructions

After returning home:

• The incisions for this procedure are in the scalp hidden by your hair. No hair is shaved.
• Ice compresses may be useful if you see bruising around the eyes 
• Rest in bed with your head elevated on 2-3 pillows
• Some oozing from the incisions is normal
• Take medication only as instructed
• It is normal to be drowsy, but try and eat a light meal the evening following surgery.
• If there is excessive bleeding, discoloration, swelling or sudden or severe pain, call the office

Next morning:

• Come to your follow up appointment at the HouseMD Plastics clinic
• If you do not have a day 1 postop appointment, please call the office between 10 a.m. and 12 noon to let us know how you are doing. The snug dressing over your forehead can be removed 24 to 36 hour after surgery.
• Keep cold compresses on and keep your head elevated as much as possible during the day
• Clean incisions with half-strength hydrogen peroxide (1:1 hydrogen peroxide to distilled water/saline) twice a day
• Apply the mupirocin ointment to the incisions twice a day after cleaning

Remainder of the first week: 

• The morning of the second day after surgery usually shows the most swelling and discoloration. It is not unusual for one eye to be more swollen or discolored than the other, or even to be completely shut. 
• Clean incisions with half-strength hydrogen peroxide (1:1 hydrogen peroxide to distilled water/saline) twice a day
• Apply the mupirocin or bacitracin ointment to the incisions twice a day after cleaning
• Sutures/surgical clips will be removed several days after surgery, usually between 6-8 days after surgery. We may leave small sections of the tape on the skin after removal.
• As the incisions are healing, they can accidentally be opened, so avoid touching the incisions for several days after the sutures/clips are out and definitely no rubbing

Healing care:

• You may resume light exercise and make-up within 10 - 14 days after surgery unless advised otherwise
• Alcohol can prolong swelling. Avoid it for 2 to 3 weeks. 
• Absolutely no smoking for at least 3 weeks to avoid healing complications
• Tearing, burning, tightness, itching, tingling, puffiness, and red and bumpy incision lines are all normal complaints and will resolve with full healing
• Full healing takes a number of months and a final check-up is advisable 5 to 6 months after surgery. Please keep your post-operative appointments.
• Keep in mind, hyperbaric oxygen (HBO) therapy may be recommended for you before and/or after surgery, if indicated by Dr. House