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Bryan G. Forley, M.D., F.A.C.S. plastic surgeon practicing in New York City - Slide 15

No one compares to Dr. Forley. His personal attention to detail is unique."

Lenard L.
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Brow Lift

Text, photos, and videos by Dr. Forley

A brow lift or forehead lift, sometimes in combination with eyelid correction, can have a very meaningful impact on an often under appreciated component of the aging face. Most patients aren’t aware of how the forehead and brow area can affect the overall appearance of the face. Even plastic surgeons often overlook this vitally important area and simply try to achieve correction with eyelid surgery alone.

A brow lift corrects more than just the brows. It lifts heavy tissue out of the upper eyelid, making the eye look fresher and more open. It can also correct the frown wrinkles between the eyes and wrinkling across the forehead. When people look at you, they make eye contact. The forehead and brow tissues affect the appearance of the eyes. If your brow tissues sag downward and they are too close to your eye, it can make you appear very stern or tired.

Low brows and forehead wrinkling can occur from heredity or from aging. Brow sagging can occur even in young individuals as early as their twenties. By lifting your brows upward, your eyes will appear larger and more open with a fresher, more energetic look. If your brow has an inadequate arch, a brow lift can often create a more pleasing shape and arch to the brow. Proper positioning of the brow is important to achieve the most improvement without creating an overly startled or unnatural look.

It is critically important to evaluate the brow position before considering any type of upper eyelid surgery. If your brows are too low and all excess skin is removed from the upper eyelid without lifting the brows, you may be unable to later have a brow lift because there wouldn’t be enough skin left in the upper eyelid to allow your eye to close properly.

fill-outIs This For Me?

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Is This For Me?

You should consider a brow lift if:

  • You want your eyes to look fresher and more open.
  • If you want to correct the frown wrinkles between the eyes.
  • If you want to correct the wrinkling across the forehead.

The Consultation

During your consultation, Dr. Forley will first ask about your medical history and to describe what concerns you most about your appearance. He will make detailed measurements of your eyelids, brow and forehead and ask you to help in determining the specific brow position and shape you like. After talking to you and performing the examination, Dr. Forley will discuss the options for the type of brow lift that he recommends. You will have the opportunity to review before and after photographs of Dr. Forley’s patients to give you an idea of the type of aesthetic outcome that typifies his approach toward surgery. He will also tell you if he feels that a brow lift would not be advisable in your case.

Preparation

Your pre-operative appointment will be scheduled 2 weeks prior to your surgery date. A complete review of the surgical plan as well as instructions for you to follow before and after surgery will be discussed. Medical clearance, including blood tests and cardiac testing as needed, will be obtained from your primary care doctor in preparation for your surgery. A program of vitamins and supplements to optimize your healing and recovery will be provided to you during your pre-op visit. Dr. Forley advocates a customized skin care regimen prior to and following surgery for all his patients and this will also be discussed. Photographs will be taken and kept strictly confidential.

The Procedure

Dr. Forley will carefully mark the incision sites within the scalp and answer any last minute questions. The anesthesiologist will then review with you the twilight/sedation technique that is utilized exclusively in our Joint Commission accredited office-based surgery facility. Dr. Forley performs almost all brow lifts endoscopically. Small incisions within the scalp are used to introduce special instruments and a miniature camera. This allows Dr. Forley to perform the surgery while visualizing the area on which he is working on a video monitor. The attachments of the brow to the underlying bone are released to permit the tissues to be lifted and repositioned upward, providing the necessary lift to the brows and reduction of wrinkling. In some cases, a more limited temporal brow lift is performed through a single incision in the temporal hair for correcting lateral brow hooding. In each case, careful fixation of the brow is performed to achieve the desired effect.

Wrinkling can occur simply due to your personal pattern of facial expression, a pattern which is almost impossible to voluntarily change. If you have marked wrinkling due to over activity of muscles of expression (frown and surprise), muscle activity can be reduced while carefully preserving normal facial expression and adequate brow movement.

No hair needs to be trimmed for this surgery. You will be placed in a turban wrap for 5 days after the surgery. After the turban is removed, you will be able to shampoo your hair. You will need to wear an elastic headband across your forehead for an additional week until your sutures are removed.

What to Expect After Your Procedure

Your forehead area will feel tight for 48-72 hours. This sensation will gradually resolve over the next several days as the swelling decreases. Most of the bruising gravitates downward into the eyelid area, and can usually be covered by camouflage makeup until it fades in 5-10 days.

You may have a moderate headache for which we’ll prescribe medication. Most patients require medication for only 2‐3 days. You may also have some scattered areas of decreased scalp sensation, which will gradually return.

Your brows may appear slightly high to you immediately after surgery due to swelling and an intentional overcorrection at the time of surgery. Your tissues will undergo a relaxation phase after surgery and, as the swelling resolves, the brows will move slightly downward.

The Stages of Recovery

  • Day of surgery: Usually performed as an outpatient procedure in our accredited office-based surgery facility. A nurse can be booked to monitor you overnight.
  • Bruising and swelling resolve: 5-10 days
  • Return to work, social activity: 10-14 days
  • Aerobic or strenuous activity: 14-21 days

We encourage a return to full normal activity very rapidly. Just don’t do any type of strenuous exercise that would push your pulse over 100 for about two or three weeks. Any aerobic activity that increases your pulse over 100 also increases your blood pressure, and could make you bleed.

Potential Risks and Complications

The risks of brow lift surgery are extremely small, but we’ll discuss all of them in detail with you when you are in the office. Risks common to all surgical procedures such as bleeding, infection and thickened scar tissue occur in a very small percentage of cases. There is a rarely occurring risk of affecting nerves that control facial movement. Dr. Forley will discuss the risks of brow lift surgery in more detail with you during your consultation.

We encourage you to discuss any concerns you may have during your consultation. If you have hypertension or high blood pressure, it must be properly controlled prior to surgery to reduce the risk of bleeding. We will coordinate this with your primary care physician. Surgical procedures involve more risk in smokers. Nicotine causes constriction of blood vessels that supply the skin, reducing blood flow, and increasing the risk of skin loss. If you are a smoker, Dr. Forley will make specific recommendations to you to reduce those risks.

Non-Surgical Options

During your consultation, Dr. Forley will discuss alternatives to brow lift surgery for you to consider should you desire a non-surgical approach. These include:

  • treatment of wrinkles with BOTOX® Cosmetic
  • non-invasive lifting and tightening with Ultherapy
  • lasers and energy devices to improve skin quality
THE AGING FACE | Dr. Forley
video brow lift

Dr. Forley was the invited author of the 'Facial Aging' chapter in Aesthetic Rejuvenation of the face and neck 2016

5 Myths About a Brow Lift

01 I will have a surprised look after a brow lift.

A surprised look does not need to be your fate when undergoing a brow lift. As with any surgery, it is important to make the proper diagnosis and choose a plan that will help to achieve the desired outcome. Lateral hooding or widening of the area between the eyes at the top of the nose..

02 A brow lift involves an incision completely across the top of my scalp.

Although open brow lifts do involve long incisions from ear to ear, Dr. Forley performs brow lifts using small incisions at the hairline and endoscopic instrumentation with a miniaturized camera to visualize the procedure under the skin. This enables faster healing and small imperceptible scars to achieve the desired brow lift effect.

03 If I have a brow lift, it will correct my heavy appearing eyelids.

A brow lift is part of a facelift.

A facelift typically includes the lower two thirds of the face and the neck. The brow lift is considered a separate procedure that can be performed by itself or in addition to a facelift.

04 The wrinkles across my forehead will be gone after a brow lift.

The frontalis or forehead muscle produces horizontal wrinkles across the forehead when you raise your eyebrows. Contraction of this muscle is often a reflexive response to a sagging brow or heavy eyelids. Once the brow sagging or eyelid heaviness is treated, the desire to constantly raise the eyebrows decreases and the depth of the wrinkles will diminish. However, it is likely that they will not completely resolve. In the past, this muscle was removed as part of a brow lift to stop the wrinkling of the skin. The contour depression that would result from removing the muscle led to muscle preservation now being the standard.

05 An open brow lift procedure is longer lasting than one performed using small incisions and an endoscope.

Although some plastic surgeons believe this to be true, Dr. Forley’s experience with the endoscopic brow lift has been very favorable both in the improvement that can be attained and in its longevity. He has followed patients that he performed the procedure on 12-15 years ago with excellent maintenance of their results.

Before & After Photos
Videos
In the Media
Blogs

MORE PATIENT EXAMPLES

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the Guide to the Top 5% New York Physicians in more than 30 Specialties Castle Connoly Top Doctor Dr. Bryan G. Forley Plastic Surgery, Fifteen Years Tatler Beauty and Cosmetic Surgery Guide 2008 VogueBeauty drs.feelgood

New York Super Doctors

Annual guide to the top 5% of New York City Physicians.

Doctors are selected from ballots sent to over 18,000 New York City physicians. Identifies those doctors held in highest regard by their peers. Dr. Forley has been listed annually since 2008.

Castle Connolly Guide-Top Doctors: New York Metro Area

The authoritative guide to finding highly qualified physicians throughout the New York region. Doctors are selected based on nominations by their peers and reviewed by Castle Connolly’s physician-directed research team.

TATLER

UK-based Tatler discussed Dr. Forley in its 2008 Beauty and Cosmetic Surgery Guide as one of the "A-list of cosmetic surgeons"..."who are at the top of their game"...and whose "innovations are shaping the art of cosmetic surgery around the world." It was noted that Dr. Forley’s "discreet Upper East Side clinic is perfect for women and men in search of minimally invasive natural-looking surgery.

Vogue

Julia Reed writes that Dr. Forley, "disarms me by asking what I might like to have done. Nothing, I say, sure that I mean it. And then he shows me before and after books of tiny little neck lifts, subtle browlifts involving tiny little incisions well hidden within the hairline. In ten years, he assures me, I’ll be thinking about it. I actually like him. And I fear he may be right."

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March 9th, 2012

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