Overview of Direct Brow Lift
As people age, the area around the eyes, including the eyebrows and eyelids, undergoes certain changes. For example, the brow can begin to sag, causing what we call dermatochalasis. This can sometimes be seen as a hooded appearance of the outer parts of the eyelids, and in severe situations, it can even obstruct the upper field of vision. Other less frequent causes of drooping brows can be facial paralysis or changes in appearance due to injuries.
There are different surgical treatments to correct the position of the sagging eyebrows. These range from traditional techniques which are performed openly, to more modern techniques that use an endoscope (a thin tube with a light and camera at the end) to view the inside of the body. Each type of surgery has its own advantages and drawbacks, and no one surgery is the best choice for all cases.
In recent times, aesthetic or cosmetic surgeries are focusing on less invasive techniques like endoscopic brow lifting. However, conventional open methods are still crucial for facial surgeons. These traditional methods provide the most accurate repositioning of the brow. This article talks about a common open technique, known as a direct brow lift, and its importance to gracefully restore the upper portion of the face.
Anatomy and Physiology of Direct Brow Lift
The top third of your face often shows clear signs of aging, such as:
* Lines that run from side-to-side on your forehead, which result from the frontalis muscle (a muscle that runs vertically along your forehead)
* A fuller than usual upper outer eyelid, caused by sagging of the upper facial tissues and drooping of the eyebrows
* Vertical and slanted lines between your eyebrows resulting from movement of specific facial muscles
* Horizontal lines between your eyebrows and at the top of your nose, caused by the procerus muscle (one of the muscles in your nose)
Relevant Anatomic (body) Structures
* The forehead has several layers, and the skin on the eyebrows is thicker than the upper eyelid. There is a fatty layer below the skin. Underneath that is a layer of muscles. The procerus muscle is near the surface, and underneath that are two others – the corrugator and frontalis muscles. Below these muscles is a thick, fibrous layer called the periosteum, which covers the underlying bone.
* The supratrochlear nerve provides feeling to the inner part of the upper eyelid, the area between the eyebrows, and a small part of the tissue lining the inside of the eyelid. This nerve typically runs through one of the muscles in our forehead, and is usually located about 1 cm to the side of the supraorbital nerve’s exit point or 1.7 cm to the side of the midline of your forehead.
* The supraorbital nerve provides feeling to the skin on the top and front part of your head and upper eyelid. This nerve exits the skull about 2.7 cm to the side of the middle of your forehead.
* The frontal branch of cranial nerve VII, facial nerve provides movement to the forehead muscles and the muscle around the upper eyelids. The path of this nerve can be identified by drawing a line from a point 0.5 cm below the small, rounded part in front of your ear to a point 1.5 cm above the outer edge of your eyebrow.
Ideal Eyebrow Position and Shape
* The classically ideal position of a woman’s eyebrow generally forms an arch, with the highest point above the brow bone’s edge, and between the outer edge of the iris (the colored part of the eye) and the outer corner of the eye. The eyebrow should have a well-defined and thicker appearance in the inner region to give a balanced and aesthetic look.
* Men’s eyebrows ideally should sit relatively flat and leveled with the eyebrow bone’s edge.
Why do People Need Direct Brow Lift
A person might need a brow lift surgery for several reasons. These include problems with seeing because of excess skin around the eyes, eyebrows sagging, paralysis of the face causing the appearance of the eyebrows to change, wrinkles on the forehead, or if the person is worried about looking angry or tired all the time.
The type of brow lift surgery a person receives can depend on their specific situation. For example, a direct brow lift could be helpful for a person who doesn’t have a lot of wrinkles on their forehead, or maybe just one eyebrow needs lifting. Also, someone with a receding hairline, heavy eyebrows or a scar around the eyebrow area may also prefer this procedure.
Despite these benefits, it’s important to note that the direct brow lift is usually only used as a reconstructive technique and is less often performed to enhance someone’s appearance.
Other types of brow lift approaches, which are usually used based on the specific patient issues, include the following:
– Endoscopic brow lift: This involves making several small cuts within the hairline and tends to heal quicker than other types of brow lift surgery. This method is not well-suited for those with receding hairlines.
– Hairline brow lift: This approach is useful in patients with longer foreheads as it can be used to lower the hairline.
– Coronal brow lift: This type of brow lift hides the surgical cut within the hair. However, it must be avoided in patients with longer foreheads as it will further elevate the hairline. Bald patients should also avoid this technique, due to the potential for an unsightly scar.
– Midforehead brow lift: This method allows lifting both eyebrows with one cut in the middle of the forehead. It’s best suited for men with a receding hairline or baldness and deep forehead wrinkles.
Each of these methods has advantages and disadvantages, so it’s important to discuss these factors with a healthcare provider when considering brow lift surgery.
When a Person Should Avoid Direct Brow Lift
There are certain conditions or circumstances that may prevent someone from having Brow Lift Surgery. These are:
Body dysmorphic disorder – This is a mental condition where a person is extremely concerned about flaws in their physical appearance, even if others see them as minor or nonexistent.
A recent eyelid surgery (blepharoplasty) – Having a brow lift soon after an eyelid surgery may lead to a condition called lagophthalmos, which prevents the eyes from closing completely.
Dry eye syndrome or a history of low tear production – This could raise the risk of lagophthalmos and worsen dry eyes (xerophthalmia).
There are also some reasons why someone might not get a certain type of brow lift, called the Direct Brow Lift. These include:
Not wanting a noticeable scar on the face – The Direct Brow Lift procedure may leave a visible facial scar.
Having thin eyebrows – Thin eyebrows may not be suitable for this type of surgery.
Having certain facial features, or wanting results that are better achieved with a different surgical technique – In some cases, another type of surgery may be a better fit for the patient’s wants or needs.
Equipment used for Direct Brow Lift
Before Surgery:
Items will be used such as a marker designed for surgical procedures, a local anesthetic given by a small needle and syringe, a solution for disinfecting the surgical area, and protection for your eyes which may take the form of a shield over your cornea or taping of your eyes.
During Surgery:
The surgeon will use various tools. Some of these include:
- A #15 blade scalpel – a small, sharp knife
- A caliper – a device used for measurements
- Different types of forceps (like the 0.5 mm Castroviejo or Adson-Brown) – used for grasping or holding tissue
- Tissue scissors (such as the Kaye blepharoplasty or strabismus scissors) – specialized scissors for cutting skin or tissues
- Needle driver (like the Halsey or Castroviejo) – a tool used for holding and driving the suturing needle through tissues
- Suture scissors (such as Mayo or iris) – special scissors for cutting sutures (threads)
- An electrocautery device – this uses electric current to cut or prevent bleeding.
- Various types of sutures or stitches, chosen by the surgeon based on what’s best for your situation (for instance, 4-0 poliglecaprone for deeper layers and 6-0 polypropylene for skin)
After Surgery:
The doctor will use an antibiotic ointment to prevent infection and will choose a type of external dressing to cover the wound or surgical area.
Who is needed to perform Direct Brow Lift?
During a direct brow lift, which is a procedure to lift your eyebrows, several medical professionals will be present to take care of you. These include:
1. A surgeon: This doctor is special and specifically trained to perform the eyebrow lift.
2. A surgical scrub technician: This is a specialist who helps the surgeon during the operation. They prepare the operation site and make sure everything is sterile (clean) to prevent infection.
3. An operating room nurse (also called a circulator): This nurse helps monitor the surgery and provides any needed supplies and equipment.
4. An anesthesiologist or nurse anesthetist: This person’s job is to give you anesthesia, which is medicine that makes you sleep or numbs part of your body, so you don’t feel the surgery.
You should note that this procedure can be done under local anesthesia (which only numbs a small part of your body) depending on both the surgeon and your choices. This means you might be awake but will not feel anything where the surgery is being done.
Preparing for Direct Brow Lift
Before undergoing the procedure, a medical professional will check the patient’s health status. This is to see if they are fit to under general anesthesia if needed.
During this checkup, the patient will be standing up while the health provider assesses the detailed physical features of the face. These include the position of the eyebrows, vision and eye movement, any wrinkles or scars, and how well the facial nerves are functioning. To best determine the natural position of the eyebrows, the patient will be asked to close their eyes and relax their facial muscles. This is important because some people with low-hanging eyebrows unknowingly keep their eyebrow-lifting muscles tense even while trying to relax.
Pictures will be taken from different angles for further reference. Extra pictures may be taken if the patient is planning to have additional eyelid surgery.
The health professional will clearly explain to the patient all the risks, benefits, and alternatives to the procedure. It’s important to discuss potential issues like uneven eyebrow positions or changes in facial sensation, difficulty closing the eyes, dry eyes, visible scarring, the possibility of repeating the surgery, hair loss, and nerve damage. Other usual risks involved in any surgery, such as pain, bleeding, and infection, are also discussed. The patient’s expectations from the surgery will be conversed and realistic goals will be set.
The procedure can help patients look younger, but that doesn’t stop the natural aging process. For example, if a 60-year-old patient looks 50 after the procedure, when they turn 70, they will likely look 60.
The patient might be advised to use a supplement called Arnica montana around the time of surgery. This can potentially help lessen bruising and swelling.
If patients need any added procedures such as an eyelid lift, fat transfer, or laser treatment to improve the look, the provider will identify and discuss this with them.
Key facial features need to be recognized for the surgery to be successful. These include areas around the eyebrows, arteries and nerves in the forehead, facial muscles etc.
General anesthesia may be used during the procedure, but it’s not always necessary. Muscle relaxants are typically avoided so that the provider can monitor facial nerves during the procedure.
Patients might receive one dose of intravenous antibiotics that fights the bacteria on the skin before the surgery.
During the procedure, lying down flat (supine position) is usually preferred.
The surgery begins by making an incision within the top line of eyebrow hair. The incision will be in a manner that lifts the eyebrows as much as desired. Most of the lifting will happen on the sides of the eyebrows to restore a natural look.
How is Direct Brow Lift performed
A direct brow lift is a procedure that is done by a skilled surgeon who knows how to work gently with body tissues and who knows a lot about the human face.
Here is an outline of what normally happens during a brow lift operation:
- The patient is prepared for the operation and a checklist is followed to make sure all the necessary steps are taken before the surgery.
- The patient is then positioned and covered with a sterile sheet to prevent infection. A safety checklist is followed and a surgical timeout (which is a pause to confirm everything) takes place.
- The surgeon will confirm how much skin needs to be removed as per the plan created before the operation. Local anesthesia (a drug that numbs the area) is used to stop pain during the operation. It also includes a small amount of epinephrine which helps reduce bleeding. If the patient is awake, bicarbonate is added to the local anesthetic to reduce any discomfort during the injection.
The surgeon uses a precise knife to make an incision (cut) in the skin, angled in such a way to ensure a good end result. Care is taken by the surgeon to make sure the cut is aligned with the eyebrow hairs to maintain the natural hairline. The cut allows the surgeon to remove the required skin and tissues while being careful not to harm the nerves and muscles underneath.
If muscles in the surrounding area contribute to drooping eyebrows, the surgeon may re-position them to give a more younger-looking appearance. In cases where there are significant wrinkles due to certain muscles, the surgeon might be able to fix that as well during the surgery.
Once all the necessary adjustments have been made, the surgeon ensures there is no bleeding.
To close the wound, dissolving stitches (ones that disappear over time) are used. The outermost layer of the skin may be closed with a non-dissolving stitch. Finally, a dressing (bandage) is applied based on the surgeon’s preference.
Possible Complications of Direct Brow Lift
While they are uncommon, there might be some complications after a forehead surgery. These include:
- Wound infections: When germs enter the surgical cut and cause an infection.
- Hematoma: This is a collection of blood outside the blood vessels, and it might happen due to bleeding during the surgery.
- Brow asymmetry: Sometimes, one eyebrow might be higher or lower than the other after the surgery.
- Forehead paresthesias: This term means a change in normal sensation in the forehead, like feeling tingling or numbness.
- Injury to the frontal branch of the facial nerve: This could affect movement or feeling in parts of the face.
- Unsightly scar formation: After the wound heals, there might be a scar that you find unattractive.
- Alopecia of the eyebrow: This means hair loss in the eyebrows.
- Need for revision: Sometimes, another surgery is needed to fix problems from the first one.
- Overcorrection: This is when too much tissue is removed during the surgery, which could affect the appearance of the forehead or eyebrows.
- Eye dryness: Some people might develop dry eyes after the surgery.
A carefully performed surgery could lessen the appearance of any scars after the procedure. For instance, if the surgical cut doesn’t extend into the sebaceous skin – which is the oily skin between your eyebrows (known as the glabella) – this can reduce potential scarring.
What Else Should I Know About Direct Brow Lift?
One of the key methods that cosmetic and restorative facial surgeons use is a direct brow lift. Direct brow lifting is a great way to exactly fix issues with eyebrows that may be uneven or drooping, which can result from either aging or facial paralysis.
A surgeon who uses this technique should also know about other types of eyebrow lifting procedures. This will help them suggest and choose the best treatment plan for you. This treatment can provide great results when performed by a qualified and proficient surgeon.