While the eyes are a major attraction point in conversation and as an indicator of facial expression, what lies about them has a major influence on them. The upper third of the face is largely composed of the brow, the forehead, and the frontal hairline. (at least in women) The position of the eyebrows along the supraorbital rim of bone and the length of the forehead skin are the important considerations in this important zone of facial real estate. Low hanging eyebrows and numerous and deep horizontal wrinkles in the forehead are common aging issues.
Browlifting (forehead rejuvenation) is often done in conjunction with eyelid tucks. (blepharoplasty) In many patients, the combination of these two produces a better periorbital rejuvenation effect that either one alone. Conversely, it is actually very uncommon to ever just do browlifting alone without blepharoplasty.
There are four different types of browlifting techniques which primarily differ in the location and length of the incisions used. One of the more commonly used in my Indianapolis plastic surgery practice is the hairline or pretrichial browlift. This is used exclusively in women who have a good frontal hairline pattern and a normal or long forehead length. While each patient is unique, foreheads that have 6 cms or more vertical length between the hairline and the upper part of the eyebrow are considered to have a long foreheads. Numbers aside, it is also important to look at how the patient’s frontal hairstyle pattern. Women how feel that their foreheads are too long or prominent, or are bothered by deep forehead wrinkles, will have bangs or a frontal swoop for partial camouflage.
The hairline browlift offers several advantages, particularly in the long or marginally long forehead. By making the incision at the hairline, this assures that it will not be pulled back as the brows are moved upward. The hairline serves as a block unlike if the browlift incision was placed back in the scalp in the traditional or coronal browlift technique. It is the forehead skin that is removed and not that of hair-bearing scalp tissue. Its second advantage is that the forehead can actually be shortened if desired. By undermining the hairline behind the scalp, it can be brought forward up to 1 to 1 ½ cmsas the brows are also lifted. This requires a position on the frontal bone to be located so that both the advancing scalp and the uplifting forehead (after skin is removed) can be secured to this predetermined position.
Recovery after a hairline browlift is the same as every other browlift method. One can expect swelling of the eyelids that will be fairly significant when blepharoplastiesare done at the same time. Bruising will always occur but it is not where one would expect. It will develop along the lower eyelids and the cheek. This is because of gravity and the forehead pressure dressing which forces everything ‘south’. The forehead will not bruise. It is not a particularly painful procedure as the forehead will largely be numb. This is the result of the muscles removed around the supraorbital and supratrochlear nerves in the brow area for furrow and wrinkle improvement. Stretching these nerves causes them to stop working for some time after surgery causing the loss of skin feeling. The feeling will eventually return to normal in a few months. The other area in which skin feeling is lost is behind the incision in the front part of the scalp. This is a peculiar feeling that patients comment on as they comb their hair. This also goes away but takes longer than that of the forehead skin.
Patients define recovery from any facial procedure as what I can ‘social’. How long until I look like I haven’t had surgery? For the hairline browlift one can expect 10 to 14 days until one looks non-surgical. The area that takes the longest to go away is the line of bruising along the lower eyelid-cheek junction. This can take as long as three weeks to go away. In the interim, foundation or mineral makeup will make it undetectable .
Dr. Barry Eppley
Indianapolis, Indiana