Brow Lift FAQ

A browlift is for women whose eyebrows are low and wish to improve the appearance of their forehead and eyes. Patients must be healthy enough to undergo an elective operation.

The aging of the face must be considered as a unit. Often – but not always – when the face ages so does the brow. A facelift only treats from the cheeks down; it does not affect the forehead and brow area. For a face to look harmonious and beautiful, it should look balanced. But though brows do drop with age, they usually drop less than plastic surgeons lift them. Overly high and arched brows or a wide gap between the brows is the most obvious telltale sign of plastic surgery. So for browlifts, tasteful and conservative should be the approach.

Like all surgery, it is a question of risks versus benefits. Dr. Teitelbaum can analyze your appearance and help you decide the extent and manner in which a browlift would improve your appearance. That needs to be weighed against costs, risks, and recovery.

The indication for a browlift is not age; it is just a question of when the brow is low enough for the procedure to be of benefit.

I never understood the logic of that. How can you correct a problem that does not yet exist? You do a browlift only when you can benefit from one.

In the old days a browlift was done with an incision from ear to ear over the top of the head. But with the invention of endoscopic instruments it was possible to do a browlift through three or four ½" long incisions hidden in the hair.

The open browlift tends to be much more dramatic; it can maintain a greater elevation of the brows. But there is much more swelling, a scar across the top of the head, and often numbness in the back of the scalp.

The open browlift tends to be much more dramatic; it can maintain a greater elevation of the brows. But there is much more swelling, a scar across the top of the head, and often numbness in the back of the scalp.

Most surgeons today almost exclusively perform the endoscopic brow lift so it is not likely you would be given a choice. And the ones who prefer the coronal browlift tend to do it most of the time. It seems, however, that women who like much higher brows – in my opinion, the "done look," will prefer the open procedure, so long as they accept the longer recovery, scars, and scalp numbness. Women who prefer a "less operated upon" appearance, the shorter scars, and easier recovery will choose the endoscopic brow lift.

The endoscopic browlift is by far the more common procedure because of the much easier recovery and better scar. But there are many excellent surgeons who more typically do the coronal brow lift.

An endoscopic browlift has between three and five ½" long incisions just behind the hairline.

There are always scars when skin is cut. In the scalp, hair does not grow within a scar. If they hair is thick, they will not be seen. If the hair is thin, the scar itself is not visible, but the absence of hair in the scar may be visible. Usually the scar can be moved back to wear the hair is thicker so that the scar is uncommonly a problem.

There are a wide variety of fixation devices, including screws, absorbable "carpet tacks," and various suture techniques. There is disagreement about which one is the best or how important they are. Dr. Teitelbaum believes results are best with the tacks.

Screws, sutures, and tacks can all be felt. The tacks take about six months or so to dissolve, and they can be felt as little lumps under the scalp. They are tender if you push on them, but if you do not specifically push on them you will not notice them.

Dr. Teitelbaum almost always prefers the endoscopic browlift primarily because to his eye the open procedure typically "overcorrects" the brow position. Dr. Teitelbaum subscribes to the old saying that a women’s brows fall with age, but not as much as plastic surgeons lift them.

A browlift elevates the brows but doesn’t touch eyelid skin. An upper eyelift removes skin of the lids, eg reducing the amount of skin between brown and lash…but it doesn’t change the brow position or shape.

The following would suggest you need a browlift: if there is "hooding" of the upper lid that extends past the end of the eye towards the crow’s feet; if when you pull up on the eyebrow to the height you think looks right your eye lid has no more hooding or bulging fat; if your brow has lost its arch; if your brow is within your eye socket. But if your eyebrow has a nice arch or is at the height that you want it to be, then an upper blepharoplasty may be what you need. But these distinctions are often subtle and it is hard for a patient to know for sure without seeing a plastic surgeon…and even plastic surgeons will have different opinions about which procedure might look the best on a particular patient.

They can definitely be done at the same time. But the important part with the blepharoplasty is removing enough to make the ideal improvement in the eyelid, yet not removing so much that there is difficulty closing the eye. With a brow lift, it is never possible to determine exactly how high the brow will end up, which in turn affects the surgeon’s decision about how much to remove. That all being said, with experience, good surgeons frequently will do both at the same time with excellent results, though it is often prudent to be more conservative with the blepharoplasty when doing the procedures together than if only the blepharoplasty were being done.

Sometimes the contribution of one is greater to the problem to the other, and a patient may want to address that first. The browlift has a longer and slightly more difficult recovery with more swelling and bruising than an upper blepharoplasty, so some patients will do that first to see if they are happy. But it makes more anatomic sense to do the browlift first. When the brow is in the proper position, healed, and settled, one can more accurately decide how much upper eyelid skin to remove. If the eyelid is done first, how much skin should be removed? Is the goal to look perfect after a future browlift or to try to do the most for now ? If the surgeon takes enough skin to maximize its appearance without the browlift, then the skin between the brow and eyelid could be too short to allow the brow to later be moved up to its ideal position without the patient having trouble closing their eye. The issues are complex, interrelated, and need to be analyzed for each individual patient.

Browlifts are very commonly done with other procedures. Most often it is a facelift, but Dr. Teitelbaum has done browlifts together with eyelifts, rhinoplasties, otoplasties, and even breast and abdominal procedures.

A browlift will reduce but not eliminate the frown lines. In the past an aggressive removal of muscles in the brow was done as a part of the browlift. It succeeded in temporarily reducing the frown lines. But without the muscles in that area, the brows would widen apart and that would look odd. It added to bruising and recovery and the nerve that gives feeling to the forehead is located in that muscle and some patients developed numbness of the forehead and scalp. If the muscles were thick, sometimes a depression would occur. And finally the muscles would often grow back. The advent of Botox™ made a difference because it is so effective at treating these lines.

The reason people develop the deep horizontal forehead lines is that they are trying to raise their brows. Once their brows are elevated, there is less of a need to lift the eyebrows. A browlift does not get rid of those lines, but it dramatically reduces them.

A browlift will not eliminate crows feet, but the effect of raising the brows often softens them. Hooding that goes beyond the end of the eye into the crows feet is significant reduced if not eliminated.

The need and frequency for Botox™ is greatly reduced with a browlift, and sometimes it is eliminated. The answer is different for each patient and depends upon the severity of their lines and what will be corrected with their browlift.

There is an adage that "a patient’s brows do drop with age, but not as much as surgeon’s usually lift them". Dr. Teitelbaum heeds this warning, believing that a high and overly arched brow is what gives the telltale sign of facial surgery more than anything else. So he is very careful to be sure that he makes the browlift look very natural. It is not just a matter of not elevating it too much, but it is to be sure that the outer brow is raised more than the inner brow.

A startled or surprised lift is usually the result of either the brow being pulled too high, or the inner brow being elevated too much relative to the outer brow. The outer brow must be higher than the inner brow, and when it is not, the patient looks startled.

This procedure is most comfortably performed with the patient fully asleep. Dr. Teitelbaum supplements the general anesthesia with local anesthesia, which provides long lasting pain relief after surgery.

Forehead numbness is a risk of a browlift, particularly if there is an effort made to remove the muscles between the eyes. The numbness can even extend past the hairline.

In rare cases there is a "visual field obstruction" as a result of a low brow and insurance will cover the browlift. But in nearly all situations insurers will deny coverage and so it becomes a procedure a patient must pay for themselves.

A browlift does not require going to an aftercare facility. But if it is done together with a facelift then you will need to stay at an aftercare facility.

There is swelling and soreness after surgery, but the pain is not significant. Still, Dr. Teitelbaum provides patients with ample pain medicine in case their pain is bothersome.

A drain is usually left in overnight and removed in the morning. By removing fluid, there is less swelling and bruising, and the recovery is faster.

When you feel ready to do your job is highly individualized. So long as your work doesn’t involve straining and heavy lifting, you can expect to be back to work after three or four days. Some people go back even sooner, and many work from home the next day.

You can drive when you are off of all narcotic pain medication and feel totally unrestricted by your discomfort such that you could make any movement you might need to safely drive your car. That is ultimately a decision that I cannot make for you.

Browlift patients can travel by airplane about a week after surgery.

I suggest you wait 3 weeks. I want to be sure that everything is healed. There is always a chance of causing bleeding if you start much before that time. When you start, listen to your body. You will be a little out of condition and a bit sore. But you will get back to where you were before surgery very quickly.

Elevating your heart rate or blood pressure, bleeding hard, or straining or sweating. But light walking is beneficial starting the day of surgery.

Sex can be resumed as you feel comfortable. Most often patients hit their level of comfort about ten days after a browlift. Again, respect the fact that you have undergone surgery and try to avoid the manipulation of the incisions.

You can lift a cooperative child that is up to 35 pounds right away. But don’t try to pick up your child if he or she is upset.

You can shower the day after a browlift. It is okay for those sutures to get wet.

Dr. Teitelbaum will see you the day after your browlift, four or five days after for suture removal, a week later, a month later, three months later, and a year later. If other procedures are done at the same time

Most patients get some bruising and swelling around their eyes after a browlift, though some get none. It usually fades by about five to seven days.

Swelling increases after surgery, usually peaking about 5-6 days after surgery. After that, the swelling will subside, rapidly at first, and then gradually. After one month, you’ll think the swelling is gone, but it will still go down more at three months, and even more at six months and even a year, though at that point changes are subtle.

No garments or dressings have to be worn after a browlift.

No particular care is required for a browlift other than just showering and cleaning the area gently for several weeks after surgery.

Browlift sutures are removed about five days after surgery.

Browlift scars are hidden in the hairline and are invisible except in patients with extremely thin hair. Dr. Teitelbaum will discuss this with you ahead of time if he is concerned about the thickness of your hair.