Brow Lift

As we age the forehead, the brows and the upper eyelid start to sag, creating heavy and droopy upper eyelids. Genetics may also contribute to heavy eye brows, as in someone who has naturally lower brows and aging lowers it further creating a hooding at the lateral upper eyelid. The good news is that with minimal incisions hidden in the scalp we can rejuvenate the forehead and droopy brows and the tired look by lifting the eyebrows and the forehead muscles to reshape the periocular area, specially the upper eyelids hooding. We have many facial rejuvenation options today including minimally invasive procedures which yield higher and reshaped brows.

A brow lift is a surgical procedure designed to improve the shape and the position of the brow, either due to aging or due to natural asymmetries. It can also improve the glabella lines or “the elevens” when we treat these muscles during the procedure as a “permanent Botox” treatment. The result is a smoother forehead and revived, younger looking periocular area. The brow lift can also be performed to simply reshape the brows, creating a more angled corner of the eye.

Before and After Photos

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Patient story

This is a female patient in her 60’s who desired a permanent improvement of the “elevens”, or glabella lines, and correction of the excess loose skin around her eyes. We did an upper and lower blepharoplasty (eyelid surgery) to remove the excess skin and puffiness of the eyelids, a complete “scarless” brow lift (full endobrow) to treat the droopy brow and the muscles in the glabella (“permanent botox” to the frown lines). We also did some fat grafting ot the upper and lower eyelids to brighten her look.

A brow lift treats central forehead wrinkles (“the elevens”) and improves the tired expression from eyelid holding.
 
Dr. Gabriele Miotto, Atlanta Plastic Surgeon

After the procedure

The brow lift is an outpatient surgery done under general anesthesia. After the procedure, there will be visible fine skin sutures in the incisions, some bruising and swelling.

A brow lift surgery is not a painful procedure, but mild discomfort and feeling of tightness in the scalp and temporal areas are expected for a few days to a few weeks after surgery. Bruising and swelling are common in the forehead and around the eyes after the procedure. Swelling can be minimal or more intense depending on how many procedures need to be done in surgery to make the results the most beautiful and natural possible. A brow lift can be combined with many other procedures for facial rejuvenation specially a blepharoplasty and fat grafting to the eyelids and temples There are many options for us to use to achieve the best results.

Sutures are removed between 5-7 days after the surgery. Return to normal daily activities between 1-2 weeks. Expect at least 8 weeks for committing to major social events as residual swelling can remain for some patients after surgery. We are all different, so it is hard to predict who will get more or less swelling and bruising.

General preoperative recommendations

What to avoid before surgery

1. DO NOT take any aspirin for 7-10 days before your scheduled procedure. Do not take NSAIDS (Aleve, Motrin, Ibuprofen) for 5 days before surgery. You may take Tylenol (Acetaminophen) if needed for aches or pains. Please contact the office at if you have any questions about any medications that you are taking or if you are prescribed aspirin by your cardiologist or Primary Care Provider (PCP).
2. Discontinue Vitamin E 10 days before surgery.
3. Avoid the following herbal supplements for 10 days before surgery: Echinacea, Ephedra / Phentermine (used for weight loss), Feverfew, Fish Oils, Garlic, Ginkgo Biloba, Goldenseal, Kava-Kava, Licorice, Saw Palmetto, St. John’s Wort and Valerian.
4. Stop Smoking. The harmful effects of smoking can cause tissue death, infection, and open wounds. It also makes you age faster!
5. Alcohol can promote swelling of the surgical area and it is best to avoid alcohol intake for at least one week before surgery.

What to take before surgery

1. You will be instructed to take a few supplements for recovery after surgery.

General postoperative recommendations

1. If the procedure is done under general anesthesia, you MUST have a responsible adult to transport you home and stay with you for a full twenty-four hours after your surgery. If general anesthesia is used, the medications used during the procedure directly affect the nervous system, and for your safety, we will not allow you to drive or be home alone immediately after surgery.
2. You will be unable to drive if you are taking narcotics.
3. It is common to feel sluggish for a few days as the anesthesia works its way out of your system.
4. It is recommended to elevate the head with two to three pillows after all facial procedures.
5. Your initial post-operative appointment will be scheduled by your Patient Care Coordinator; please make arrangements to have reliable transportation for these appointments as you will not be permitted to drive until twenty-four hours after your surgery and when you are no longer taking narcotic pain medications.

Activity

1. For your safety, we require that you have a responsible adult stay with you for twenty-four hours after your surgery for general help, as you may find your balance and judgement impaired.
2. Please refrain from physical activity that will increase your heart rate or blood pressure for 2 weeks after surgery. However, bed rest is NOT recommended, and you should be walking at normal pace after the procedure.
3. Frequent walking will decrease the risk of post-operative blood clots (mostly after general anesthesia).
4. Sexual activity can safely be resumed 2 weeks following surgery. Please discuss with Dr Miotto as needed.

Bathing

1. You can shower twenty-four hours after surgery. You may clean the incisions as instructed by Dr Miotto or her nurses after the procedure.
2. Do not submerge yourself into a tub/pool until all wounds have healed (usually in 3 weeks).
3. Do not scrub the surgical sites, however you can allow soapy water to run over them.
4. Avoid lotions on the surgical sites for 2 weeks, but you can moisturize any other areas as desired.

Returning to work

1. Recovery time will vary; however, most patients return to work within one to 2 weeks after the procedure, within one week you will have a feel for your specific limitations and will be able to determine how comfortable you will be with resuming your daily activities and workload.

Diet

1. Immediately following surgery, it is best to eat bland, easily-digested food and avoid excess sugar and salt. Healthy proteins (eggs, lean meat, beans, nuts), rice, fruits and cooked vegetables (broccoli, peppers, sweet potatoes) will provide your body with nutrients essential for healing.
2. Eat a few bites of food before taking pain medications as these can cause nausea.
3. A diet low in sodium will help minimize swelling and water retention.
4. Drink plenty of water! Drinking low sugar sports drinks and protein shakes are recommended.

Final results

1. Keep in mind that our goal in aesthetic surgery is improvement and not perfection. You will be followed closely after surgery to assure that you heal well and have the best possible results.
2. It can take months for the very final results of your surgery be apparent, but the new brow shape is noticeable right after surgery. After 12 weeks, you can expect your results to be mostly permanent. Expect subtle changes in swelling and healing to continue to improve for up to six-twelve months.
3. It is important for you to keep open communication with your physician and return for your follow up visits. We will take pre and post pictures along the way and look at the final results together.

Dr. Gabriele C. Miotto is a Brazillian-American plastic surgeon specialized in aesthetic surgery and minimally invasive procedures, specially of the face, eyes, nose, breast and liposuction. Call (404) 850-5851 for your consultation.

Brow lift / forehead lift

A brow lift (aka forehead lift or forehead rejuvenation procedure) improves the wrinkles and frown lines that develop across the forehead. In addition, since a forehead lift places the patient’s eyebrows in a more youthful position, if he or she also has droopy-looking eyelids this facial characteristic improves as well. After a forehead rejuvenation procedure, the wrinkles on the forehead and the vertical lines between the eyebrows (11’s) are less visible. Furthermore, since the patient’s eyelids no longer droop, he or she appears awake and more alert.

What causes the changes that me plastic surgery can address with a brow lift?

As time passes, the skin and soft tissues in the face lose a substantial amount of elasticity. This loss of elasticity occurs due to a decrease in collagen production. In addition, the Earth’s gravitational pull as well as a gradual shortening of the space between the eyelashes and eyebrows causes an individual’s brow to sit lower on the face. This descending brow can cause wrinkles and lines to develop, it can also lead to droopy upper eyelids.

Genetics may also contribute to eyebrow drooping because as an individual with low-lying eyebrows ages, his or her eyebrows continue to fall. Individuals who have eyebrows that naturally sit lower on the face may experience hooding of their lateral upper eyelids.

How these forehead changes can affect an individual’s appearance

After a brow lift at ME Plastic Surgery in Atlanta, the patient no longer has the facial characteristics that incorrectly dictate his or her emotions. Now the patient enjoys a refreshed, more youthful appearance.

Forehead rejuvenation techniques

Although there are several forehead rejuvenation techniques, Dr. Felmont Eaves and Dr. Gabriele Miotto of ME Plastic Surgery in Atlanta typically perform the endoscopic brow lift.

There are three forehead lift techniques

1. A temporal lift (aka lateral brow lift) —the plastic surgeon creates an incision in the hairline near the temple, this incision allows the surgeon to lift the eyebrow area upward and outward.
2. A classic lift (aka traditional lift, open lift or coronal lift) —during a classic lift, the surgeon creates two incisions on the top of the patient’s head, bringing the ends of the incisions together. Initially, the classic lift was the standard brow lift procedure, however, due to advancements in the plastic surgery industry the classic lift is no longer the standard.
3. An endoscopic lift —this type of forehead lift is a minimally invasive procedure. The surgeon strategically places each incision in an area of the patient’s hairline that allows the plastic surgeon to easily access the structures of the forehead.

Candidate

Consultation

Upon arriving for an initial consultation with Atlanta plastic surgeon Dr. Miotto or Dr. Eaves, patients fill out registration information. For this reason, we request that patients come about 15 minutes early.

Patients who take medications, herbal supplements and vitamins may find it helpful to make themselves a list that they can use while filling out their registration information. Or the patient can create a list specifically for his or her medical file.

On this medication list, include the medication dosage amount, frequency taken and the reason for each medication. In addition, please provide allergy information (e.g., latex, baclofen, etc.) on this list. Patients who regularly take herbal supplements and vitamins need to add this information to their medication list; please include the same descriptive information (e.g., frequency taken, etc.) for these products.

Dr. Felmont Eaves and Dr. Miotto need to know about all these medications, herbal supplements and vitamins because the patient may need to discontinue taking or reduce the dosage amount of certain products before having a forehead lift.

If a patient has had quite a few surgical procedures or medical treatments, creating a list outlining these is also helpful. Please include the year of the procedure or treatment, the reason for the surgery, or treatment as well as if there were any complications.

Dr. Eaves and Dr. Miotto want to know

Please keep in mind that every question the surgeon asks is important and therefore, candid answers are vital to ensuring the patient’s safety.

At this consultation Dr. Miotto or Dr. Eaves will:

Should the patient decide to have a brow lift, the surgeon takes photographs of the patient’s face. The plastic surgeon uses these photos during the creation of the patient’s custom-designed forehead rejuvenation plan.

Dr. Miotto and Dr. Felmont Eaves encourage questions. Just as with the medications, treatments and surgeries, some patients find it helpful to create a list of questions to bring on the day of their consultation.

Preparing

While preparing for a forehead lift, patients must follow the preoperative recommendations listed below.

Before surgery

For 10 Days

For 10 days prior to their forehead rejuvenation procedure in Atlanta, patients must discontinue taking vitamin E as well as the herbal supplements listed below

From seven to 10 days

For a week to a week and a half before a forehead lift, patients must stop taking aspirin as well as any medications that contain aspirin. Patients who take aspirin because of a recommendation from their primary care physician or cardiologist should discuss this issue with Dr. Gabriele Miotto, Dr. Eaves or the physician who made the recommendation before discontinuing it. Moreover, patients should never discontinue or decrease the dose of their medications, especially prescription medications, without first speaking with the prescribing physician.

For five days

For five days before surgery, patients must not take any non-steroidal anti-inflammatory drugs (NSAIDs). Medications within the NSAID class include Motrin, Aleve and ibuprofen. NSAIDs tend to increase bleeding, which can cause unnecessary bruising.

Patients can safely take tylenol for pain

Patients who require medication to relieve pain within 10 days of their forehead lift can take Tylenol (aka acetaminophen, non-aspirin).

Do not drink alcoholic beverages

Alcohol increases inflammation, which can lead to additional bruising and unnecessary discomfort. Therefore, patients must not drink any alcoholic beverages for a week before and then a week after their brow lift in Atlanta.

Four weeks before and four weeks after a forehead lift patients must stop using any products containing nicotine

Stop using any products containing nicotine (e.g., traditional cigarettes, e-cigarettes, chewing tobacco, nicotine patches, etc.). It is essential for patients to discontinue using these products because nicotine causes the blood vessels to contract. Once a blood vessel contracts. This slower circulation makes it take longer for the blood that carries the oxygen and nutrients to reach the incisions, resulting in a slower healing process. Due to this slow healing, the patient increases his or her risk of developing an infection, experiencing an open wound and necrosis, which is the medical term for tissue death.

Complete all lab tests and medical evaluations a week before the forehead lift in atlanta

If Dr. Miotto or Dr. Eaves orders blood work, a medical evaluation or any other type of lab testing, patients need to complete these tests no later than a week before their brow lift.

Find a driver and a caregiver

Patients receiving general anesthesia or twilight anesthesia (i.e., IV sedation with local anesthesia) must ask someone they fully trust to drive them to and then home from their forehead lift. This individual must be physically capable of assisting the patient with walking. In addition, the surgeons at ME Plastic Surgery want their patients to have someone remain with them for at least 24 hours after their forehead lifts. Ideally, the individual that drives the patient home will also serve as his or her caregiver for 24 hours.

Patients arriving alone on the day of their forehead lift must reschedule

If a patient arrives for a brow lift without a driver, the surgeon is unable to perform the patient’s forehead rejuvenation procedure. Nonetheless, once the patient finds a driver and caretaker, the patient can reschedule the forehead lift.

For-hire transportation in atlanta

The plastic surgeons at ME Plastic Surgery do not allow their patients to take public or for-hire transportation following procedures that require twilight or general anesthesia. The surgeons of ME Plastic Surgery abide by this policy to keep their patients safe because after having anesthesia, a patient is somewhat vulnerable. Although rare, there are times when Dr. Miotto and Dr. Felmont Eaves perform brow lifts using just local anesthesia.

Open Brow Lift

For the most part, plastic surgeons generally prefer the endoscopic forehead rejuvenation procedure over the traditional open brow lift. Therefore, plastic surgeons rarely perform traditional lifts anymore. Nonetheless, for comparison purposes, detailing both the open forehead lift and the preferred endoscopic lift helps demonstrate the benefits of an endoscopic brow lift.

Procedure

Pre-op

The surgeon sees the patient in the pre-op area. With this type of forehead lift, the surgeon shaves a section of the patient’s head, takes measurements and marks the incision sites. Since some patients feel anxious about having their head shaved, measured and marked, the surgeons at ME Plastic Surgery may wait to prepare the patient’s head for surgery until the patient is asleep.

The incisions for an open forehead lift

The incision for an open forehead lift starts in the patient’s hairline above the ear. The incision continues across the patient’s scalp following the hairline and spanning from ear to ear.

The surgeon creates another incision in the same manner, bringing the incisions together and tapering them at each end.

The surgeon lifts the forehead into its new position. The scalp in front of the incision overlaps the scalp behind it.

The plastic surgeon removes the overlapping section of the scalp and brings the remaining skin together, using sutures to close the incisions.

Candidate

Individuals with high foreheads, people with thin hair and those who are likely to lose their hair are not good candidates for an open brow lift.

Endoscopic Forehead Lift

An endoscopic brow lift typically takes an hour or two. Please keep in mind that patients having more than one procedure during the same surgical session will be in the operating room longer.

The surgeon visits the patient while he or she is in pre-op. During this visit, the surgeon answers the patient’s questions and may discuss specifics related to the patient’s endoscopic brow lift. The surgeon may also make several markings within the patient’s hairline. These markings serve as a guide during surgery as each one represents the location of an incision.

The patient receives medications that put him or her to sleep. General anesthesia places the patient in a deep sleep, whereas, twilight anesthesia causes the patient to fall into a lighter sleep. The benefit of twilight anesthesia is that the patient does not have to worry about the side effects associated with general anesthesia (e.g., nausea, etc.). Furthermore, with twilight anesthesia patients are easy to arouse after surgery.

Endoscopic Lift Incisions

Dr. Gabriele Miotto or Dr. Eaves create tiny incisions (from 3- to 5-cm in length) in the patient’s scalp. Through these incisions, the surgeon removes any excess tissue and repositions the brow returning it to its original location or, if necessary, the plastic surgeon reshapes the periocular area to address the patient’s hooded upper eyelids.

Since Dr. Miotto and Dr. Eaves perform a brow lift using small incisions they create in the patient’s scalp, there is no need to shave or remove any of the patient’s hair.

Although these incisions leave behind very tiny scars, due to their location within the hairline, they remain well hidden.

After creating the incisions, Dr. Miotto or Dr. Eaves inserts a long, thin tube through one of them. This tube has a tiny camera and a light mounted on the end of it (i.e., an endoscope). Using the endoscope, the surgeon views the tissues and muscles in the patient’s forehead. The plastic surgeon uses the other incisions to insert additional surgical instruments.

The surgeon gently releases and then lifts the forehead tissue.

The surgeon then removes the excess tissue.

Using either sutures or small titanium anchors that resemble screws (with a width of 2 mm) the plastic surgeon secures the patient’s muscles. Dr. Miotto or Dr. Eaves secures the muscles by anchoring them to the bone. These titanium anchors can be permanent, or they can be removable.

Dr. Gabriele Miotto or Dr. Eaves closes the incisions using small sutures.

Gauze and a small drainage tube may be present following the forehead lift.

Recovering

Approximately a week later patients return to the office for suture removal.

Following a forehead rejuvenation procedure patients experience minimal pain, however, slight discomfort is likely. Most patients state that this discomfort feels like a tight sensation throughout the forehead, scalp and temples. This sensation can last anywhere from a few days to several weeks.

Much of the bruising and inflammation around the eyes and forehead resolve within two or three weeks of the forehead lift.

Each patient is unique, which is why it is difficult to provide patients with an exact recovery timeline.

A General Recovery Timeline Following Forehead Rejuvenation Surgery

To prevent complications, patients need to remain active as they recover.

On the day of their brow lift, patients should walk around their house periodically.

Patients can shower 24 hours after their forehead lift, however, due to the incisions patients should be gentle while washing their hair.

Patients with sedentary jobs can return to work about a week after their forehead lift.

If a patient has concerns related to the visible bruising on the face he or she can camouflage the bruises with makeup.

A week or two after a brow lift patients who are not taking prescription medication for pain and have full mobility can resume driving.

Two to four weeks after a forehead lift, patients can gradually begin exercising. Dr. Gabriele Miotto or Dr. Eaves can provide guidance as to which exercises are safe for the patient to perform as he, or she recovers.

Inflammation may be minimal or intense. The severity of the swelling and bruising a patient experiences depends on the number of procedures he or she has during a single surgical session.

Most patients can resume their usual daily activities within a week or two of their forehead lift.

A patient needs to wait at least eight weeks before making a commitment to attend a major social event. Waiting this length of time ensures that the inflammation has subsided.

Complications and Risks

If a patient chooses an experienced plastic surgeon to perform his or her brow lift in Atlanta, the likelihood of a complication decreases.

Potential Complications and Risks

How much does a brow lift at me plastic surgery cost?

Since the only way a surgeon can determine how much your procedure would cost is by examining you and discussing what you want to achieve, consider scheduling an initial consultation at ME Plastic Surgery.

Dr. Gabriele C. Miotto is a Brazillian-American plastic surgeon specialized in aesthetic surgery and minimally invasive procedures, specially of the face, eyes, nose, breast and liposuction. Call (404) 850-5851 for your consultation.

FAQ