Brow lift

What are the causes of a droopy brow?

• Most often the brows drop due to gravity and ageing changes.
• The brows normally sit above the bony ridge (women) or on the bony ridge (men) can gradually drop which leads to the appearance of excess skin on the upper lids.
• Some patients have naturally low brows.
• Facial nerve palsy of any cause weakens the forehead muscles and causes the brow to drop.

What are the potential benefits of brow lift surgery?

• The appearance of bigger and more youthful eyes and more alertness
• Restoring the normal appearance of the upper face and upper eyelid
• Improving symmetry with the other side
• An improvement in the upper part of your field of vision
• Reduced headaches. Some patients compensate for low brows by using their forehead muscles constantly, which can cause a headache.

What does the direct brow lift operation involve?

Removal of tissue just above the brow is carried out as day case surgery, generally under local anaesthesia which means you will be awake for the procedure. Occasionally the surgery is performed under local anaesthetic with sedation.

Mr Lin will use a surgical pen to mark out the tissue to be removed, which is the most critical part of the operation for symmetry. Anaesthetic is then injected under the skin, which feels sharp and stings for about ten seconds. After this the eyelid will be numb and the surgery should not hurt, but you may still feel touch, fluid or pressure.

The excess skin is cut away. The wounds are then closed with stitches that minimise scarring. The scar – if there is any – is partially hidden by the hairs of the brow.

At the end of the operation, ointment is put on the wounds and dressings applied to the eyelids to reduce bruising and swelling. Both dressings will be removed before you leave.

There are many alternative options including:

• A browpexy which is a stitch that secures the brow higher on the forehead without any excision of skin or fat. As a result healing is faster leaving a minimal scar (external approach) or no scar (when combined with a blepharoplasty), however this operation provides less lift compared with a direct brow lift.
• An endoscopic brow lift where the incisions are made at the hairline and the brow is raised using an endoscopic camera. This reduces the chance of a visible scar, however has less effect on raising the brow compared with a direct brow lift.

What problems can occur after the operation?

Mr Lin performs many hundreds of operations each year and will draw on his expertise to minimise the risk of problems.

• Bruising and swelling is normal. These changes will settle after a few weeks, and will take longer to resolve in patients with blood thinners.
• Dry, gritty, sensitive eyes for a few weeks can be helped with lubricant eye drops. The vision may be slightly blurred for a few days. A dry eye problem may be worsened by the surgery, and more frequent lubricating eye drops may be required
• Bleeding after the operation is usually slight and stops within a short time. If bleeding continues you should contact the hospital in case further treatment is required.
• Several nerve run under the fat under the skin. Rarely if these are damaged, there can be temporary or permanent numbness
• A post-operative infection may rarely develop in the lids when they would become tender, red and more swollen and the wound may open and discharge. If this happens then you should contact the hospital as antibiotic tablets may be needed to help correct this and allow the lids to heal.
• Very rarely there is a noticeable asymmetrical result and further surgery may be required.
• Very rarely too much skin is removed and cause a surprised look, which may require a skin graft correct.