Brow Lift in Miami, FL
Double board-certified oculofacial plastic surgeon, Gregory D. Lewen, M.D., offers brow lift procedures for men and women in Miami, Aventura, and the surrounding areas of Florida. Dr. Lewen is one of the few plastic surgeons in the area who specializes in plastic surgery of the eyes.
What is a Brow Lift?
The brow and forehead areas can commonly show some of the first signs of aging as loss of volume tends to occur in this area somewhat earlier than in other areas of the face. A person’s actual age is not the only factor that contributes to some of the premature signs of aging in this part of the face. Sun damage and other environmental stresses, combined with the natural loss of collagen, elasticity, and overall volume in brow tissues over time, can lead to a loss of structure and fullness in the brows. As the brows start to show some signs of aging, gravity can also play a role in causing some of the skin in this area to sag. As the brows start to droop a little, this can sometimes be perceived as a feeling of heaviness in the upper eyelids. Others may not even consciously realize that their brows are starting to droop, but may learn to sub-consciously raise their brows as a part of normal expression, and in order to alleviate some of the feeling of heaviness. Frequently, this can result in exaggerated frown lines, wrinkles across the forehead, and/or increased heaviness of the eyebrows and upper eyelids. These changes can contribute to an appearance that may be interpreted by others as a tired, angry, or sad expression that may not accurately reflect the way you actually feel.
A youthful female brow is typically more arched and sits in a position at or slightly above the bony rim of the eye socket. A youthful male brow is typically flatter and positioned at the level of the bony rim of the eye socket. In both males and females, aging of the brow and forehead areas can cause the brows to sag, and in some cases, they can droop over onto the upper eyelids to create the feeling of additional heaviness in this area. It is important to understand that although drooping brows can contribute to heaviness in the upper eyelids, this is not the only cause.
If a patient has droopy brows and excess tissue in the upper eyelids causing the appearance of heaviness in this area, a brow lift is frequently performed at the same time as an upper eyelid surgery. In some of these cases, if a brow lift procedure is not performed at the same time as upper blepharoplasty, the brow position may actually become lower after eyelid surgery as the brow can become tethered lower after the eyelid incision heals. For this reason, it is important to consider the possible need for a brow lift procedure at the time of your initial surgical consultation.
If expression lines or other signs of aging in the brow region bother you, a brow lift may be the solution.
What Are the Benefits of a Brow Lift?
Depending on the specific type of procedure, brow lift surgery (also known as forehead lift surgery) can:
- Minimize the creases that develop across the forehead or those that occur high on the bridge of the nose, between the eyes
- Improve what are commonly referred to as frown lines, vertical creases that develop between the eyebrows
- Reposition a low or sagging brow that is hooding over the upper eyelid
- Raise the eyebrows to a more alert and youthful position
- Correct contour irregularities
Where is Brow Lift Surgery Performed?
Depending on your individual case, Dr. Lewen may recommend for your surgery to be performed in an outpatient (ambulatory) surgery center, where you will go home the same day. In these cases, IV sedation is typically given for the procedure to induce a “twilight sleep,” and local injections of anesthesia are administered. A standard medical clearance is required prior to surgery to ensure that you are healthy for surgery. This clearance typically includes basic bloodwork, a medical history and physical exam, a recent EKG from your primary care physician or your cardiologist, and a urine pregnancy test if applicable. Dr. Lewen only chooses to perform brow lift surgery for his patients in specific facilities that meet his qualifications for providing exceptional patient care. These facilities have dedicated and attentive nursing staff and a board-certified anesthesiologist on site to ensure that your experience is as safe and comfortable as possible.
For some patients, Dr. Lewen may offer the option for your brow lift surgery to be performed in his office procedure room. If performed in the office setting, Dr. Lewen may give you a light oral sedative prior to the surgery in order to help you relax, and to make it easier for local anesthetic injections to be administered to your brow areas. Regardless of where your surgery is performed, you will require someone else to drive you home on the day of your surgery.
What Should I Expect from a Brow Lift?
There are many different forms of brow lift procedures that Dr. Lewen commonly performs. The best procedure for an individual patient can only be determined after careful examination and discussion about your cosmetic goals during your consultation. The various brow lift procedures that Dr. Lewen performs include:
- Internal browpexy
- External browpexy
- Direct brow lift
- Endoscopic brow lift
- Temporal brow lift
- Trichophytic (open) brow lift
Browpexy procedures are a much less invasive form of brow lift surgery that provide smaller amounts of lift or stabilization of the brow position, and are usually performed at the same time as an upper eyelid surgery. The benefit of these brow lift procedures is that there is usually little to no associated downtime. An internal browpexy is performed by approaching the brow through the same upper eyelid crease incision that is made during blepharoplasty. An external browpexy is performed by making a small incision above the outer portion of the brow. Both procedures involve a simple release, repositioning, and stabilization of the brow tissue.
Direct brow lift surgery is typically performed in cases of severe brow drooping. This is Dr. Lewen’s procedure of choice for patients who have very droopy brow position related to issues of facial nerve or forehead muscle weakness. This procedure involves the placement of an incision either directly above the brow hairs, or hidden in a deeper horizontal fold across the forehead. After the incision is made, a measured amount of tissue will be removed, and the area will be sewn closed in layers to provide a substantial lift to the brow area. Although this procedure is very effective for addressing droopy brows, it is more common to have some degree of a visible scar above the brow or on the forehead after undergoing direct brow lift surgery. For this reason, this form of brow lift surgery may not be ideal for patients who desire the best possible cosmetic result.
Endoscopic brow lift surgery is an excellent procedure, which utilizes small incisions made in the hairline. Since these incision sites are hidden well within the hairline, this is an ideal surgical option for many patients who are more concerned about having the best possible cosmetic results. Using an endoscope (for visualization, the size of a drinking straw), the forehead and brow muscles that worsen frown lines are released and sagging brows and skin are physically lifted. After the brow and forehead muscles are fully released, dissolvable anchors are placed to hold the lifted brows in place through the initial healing phase of surgery. Dr. Lewen uses different anchors for this procedure depending on the amount of brow drooping that is present, and the amount of brow lift that is desired. While all of these anchors will dissolve on their own, some may take a little longer than others until they are completely gone. Initially, the anchors may appear as small bumps under the skin just at the level of the hairline until they are fully absorbed.
Temporal brow lift surgery is the ideal procedure to address drooping brows that are more significantly affecting the outer portion of the brow. Similar to an endoscopic brow lift, this procedure utilizes an incision made at the hairline in the temple area that is well-hidden, and is much more likely to heal without a significant, visible scar. For this reason, temporal brow lift surgery is another excellent procedure for patients who desire the best possible cosmetic result. After the incision is made in the hairline, Dr. Lewen will carefully dissect down to the brow area, and release some of the tissue that holds the brows fixed in place. A conservative amount of tissue excision is usually performed, and sutures are placed to close the incision site in layers carefully. Dr. Lewen does not typically utilize an anchor when performing temporal brow lift surgery. This procedure is ideal for many patients who have significant brow droop affecting more of the outer portion of the brow, but who are still looking to have the best possible cosmetic result.
Trichophytic (open) brow lift surgery typically involves a more significant dissection and release of the brows to achieve a greater lift. This surgery involves an incision that is made fully across the hairline in order to allow for a more substantial release and repositioning of the forehead and brow tissue. The incision is constructed in a specific manner to blend into the hairline as best as possible. After the forehead and brow tissues are lifted, excess tissue may be excised, and the incision is sewn back together in layers to minimize the appearance of the scar as much as possible.
It is important for all patients having brow lift surgery to understand that while lifting the brow position may certainly help to improve the appearance of the upper eyelids, Brow lift surgery alone may not give a significant enough improvement in this area. Brow lift surgery is not intended to change the shape or position of the eyelids. For this reason, brow lift surgery is usually performed in combination with upper eyelid blepharoplasty in order to achieve the best cosmetic improvement in this area of the face.
If you are concerned about the cosmetic appearance of extra skin in your brows or your upper eyelids, you should discuss these concerns with Dr. Lewen at the time of your consultation.
Other rejuvenation procedures can often be performed in conjunction with brow lift surgery. Most commonly, these include:
- Upper blepharoplasty and/or lower blepharoplasty to rejuvenate the appearance of aging eyes
- Mid-face lift to correct aging changes in this region
- CO2 laser resurfacing for skin of the eyelids and face
- Facial fat grafting to restore areas of volume loss
- Ptosis repair
- Facial filler injections
What is a Non-Surgical Brow Lift?
While brow lift surgery is the only way to treat moderate-to-severe aging in the forehead and brow areas in a natural and lasting manner, many patients are not looking for a greater change in this area, and may not require a surgical brow lift. Such patients, who may be looking for a more mild-to-moderate brow lift, may be able to achieve excellent results with a non-surgical brow lift. Dr. Lewen can utilize a combination of advanced injection procedures to perform a non-surgical brow lift in the office setting, and with minimal downtime.
This technique can be performed with precise injections of neuromodulator medications such as Botox®, Dysport® and Xeomin®, as well as from injectable facial filler products such as Restylane®, Juvéderm®, Radiesse®, and Voluma®.
Skillfully placed Botox® injections can selectively relax the muscles that pull the brows down and allow the elevating muscles to remain selectively active. This generally produces a subtler brow lift, but is not the same for all patients. Injecting facial filler under the eyebrow serves to fill an area where volume is lost as part of the normal aging process. This can serve to re-inflate and lift a mild-to-moderate drooping brow. For some patients, injection of facial filler into the hollow areas of the temples or deflated areas of the lateral brows can also serve to lift the outer portion of the brows as well. These non-surgical options are relatively painless and can easily be performed in the office with little to no associated downtime, depending on the exact procedure(s) that you require to achieve your desired results.
It is important for patients to understand that this type of brow lift will not give the same results as those from surgical procedures, and they are not intended to do so. Rather, these are minimally invasive options that can produce some amount of brow lift and rejuvenation for patients with smaller amounts of brow droop or for those who do not desire to have surgery.
What Should I Expect After a Brow Lift?
Brow lift surgery is generally a very safe and relatively painless procedure. Pain tolerance among patients can vary considerably. However, Dr. Lewen and his staff routinely show careful consideration to individual patient sensitivities in this delicate area of the face. Some mild soreness can be present in the first week or so after undergoing surgery, but this can vary depending on the type of brow lift surgery that is performed.
If brow lift surgery is done in combination with an upper eyelid surgery, it is possible to have some discomfort following surgery that can be related to a dry eye condition. Dr. Lewen will spend significant time with you during your surgical consultation discussing your dry eye risk factors, along with the precautionary steps that he recommends for you to take to ensure that you have the easiest time and least amount of discomfort through the healing process.
When considering any brow lift surgery, it is important to inform your surgeon of any abnormalities of your eyes, your vision, or your general medical health. Dr. Lewen requires all functional and cosmetic brow lift surgery patients to have a full eye exam with dilation completed by your primary eye doctor within the last year before scheduling surgery. Surgery should be scheduled for a time when you can relax for at least one to two weeks, although this initial healing time may be somewhat longer for certain brow lift procedures. It is important to avoid any strenuous activity, heavy lifting, or bending down during this time to avoid complications and to promote the best healing situation. Depending on the amount of brow droop that is present, and the type and extent of brow lift surgery that is performed, patients can have somewhat variable amounts of recovery time. For the average patient undergoing brow lift surgery, most of the swelling and bruising is generally healed in the first few weeks after surgery.
It is also important to avoid taking any blood-thinning medications or supplements for at least two weeks prior to surgery. Dr. Lewen’s staff will review a list of common medications, supplements, and vitamins that can cause your blood to be thinner.
Please note: If you have been placed on a blood-thinning medication by your doctor for a medical reason, you will need to ask your doctor’s permission before stopping any such medications. Dr. Lewen will never instruct any patient to stop taking a blood-thinning medication without first consulting with a primary care physician.
Depending on the type and extent of surgery that is performed, it can be normal to have some amount of numbness of the forehead area immediately after brow lift surgery. Typically, this numbness is only temporary and will show gradual improvement throughout the healing period until full sensation has returned.
If you have any additional questions or concerns about downtime following brow lift surgery, please contact one of Dr. Lewen’s patient coordinators to learn more about what can be done pre- and post-procedure to ensure that you have as little downtime as possible!
How Long Will the Results from Brow Lift Surgery Last?
It is important to understand that, while brow lift surgery can be expected to correct certain conditions more permanently, your body will continue to age naturally. Life-long sun protection and good skin care are important tools that will also help to maintain your results. Depending on the type and extent of brow lift surgery that is performed, you can typically expect results to last from five to 15 years.
How Much Does a Brow Lift Cost?
The consultation with Dr. Lewen takes about 30 to 45-minute consultation, after which we discuss cost and our financing options.
Dr. Lewen is one of the few plastic surgeons in the Miami and Aventura, Florida area who specializes in plastic surgery of the eyes, including brow lift surgery. Contact us today to schedule a comprehensive consultation to learn more about our services.