Through the Keyhole

Created on 24th February 2009

Cosmetic surgeon Rajiv Grover explains how the appearance of the eyes can be transformed with an endoscopic brow lift

Ageing within the upper thirdof the face leads to drooping of the eyebrows, horizontal lines on the forehead and hooding of the upper eyelids. This occurs because the attachment of the eyebrow itself above the eye socket weakens with age, gravity and with the activity of the frown muscles. This leads to a closed appearance to the eyes which can appear tired or angry.

Many beauty treatments such as threading and semipermanent make-up try to disguise this by artificially positioning the brows a little higher but often something more is required.

The appreciation that the eye is one of the key focal points of the face has made brow lifting one of the hottest surgical procedures, initially in Hollywood and now across the world.

The importance of the brow
As early as the time of Queen Nefertiti the brow was recognised as an important element in emphasizing the eyes. Nefertiti was buried in her tomb with her most prized possessions which included instruments for brow shaping and pencilling.

In the world of art even minimalist representations of the face use the brow to emphasize the eyes, such as the work of Andy Warhol where only the bare essentials of the face are included but always a very definite high brow to draw you into the eyes and mesmerise the onlooker. In the field of aesthetic surgery, techniques for rejuvenating the upper third of the face have been revolutionised in the past decade with keyhole surgery.

What can be done?
Repositioning the brow and forehead gives an open appearance and fresh look to the upper third of the face which are characteristic of youth and beauty. The procedure for rejuvenation of the forehead and eyebrows is known as a brow lift. It aims to compensate for the drop in brow position that occurs with age although this can take place at a relatively young age in certain individuals with a familial tendency to early drooping. If the eyebrows drop it also creates the impression that the upper eyelid has excess skin as it all gathers between the eyebrow and the upper lid giving a hooded appearance

The brow lift operation is performed using the endoscopic (or keyhole) technique. This utilises a surgical telescope (endoscope) to lift the brow and forehead without the need for visible scars. The three incisions are short (10-12 mm) and kept within the scalp behind the hairline in order that there are no visible scars.

The operation of endoscopic brow lift is often performed in conjunction with surgery to the eyelids for removal of loose skin or bags (blepharoplasty).

What does the operation involve?
Endoscopic brow lift is performed under a general anaesthetic and no hair is shaved or cut as it can easily be parted with gel and ribbons to give adequate access for surgery. The incisions are then made in the scalp and kept behind the hairline to prevent any visible scars on the forehead. The tissues of the forehead are then lifted and repositioned higher. At the time of the surgery the frown muscles can be weakened as well as lifting of the brow.

I am always careful to judge the position of the brow carefully in order to avoid creating a startled appearance after surgery. The skin is then supported in the new position and the wounds are stitched with dissolving sutures. The operation usually takes less than an hour and no dressings or bandages are needed.

What can I expect after the surgery?
There is usually very little swelling and bruising following endoscopic brow lift as the procedure is minimally invasive and performed with only keyhole incisions. However this does vary depending on whether any eyelid surgery was performed at the same time. Although this is not a  painful operation for the first few days it is common to experience some headache in the forehead region after browlifting as the nerves to the scalp in this area are stretched.

It is advised to rest for the first few days with your head elevated on 2-3 pillows as this speeds recovery. During the first week you should avoid straining and bending down as this tends to increase the swelling. As the stitches are dissolving and hidden in the scalp there will be no sutures to remove.

Most patients can return to work after about seven to ten days although it will probably take at least two weeks before you would be ready for a major social event. To aid recovery strenuous sport should be avoided for two to three weeks.

What are the risks?
It is important to stress the possibility of risks although in practice these are rare and endoscopic brow lift is an operation with a high level of patient satisfaction and a reliable outcome.

It is common to have a headache for the first few days following a brow lift due to stretching of the nerves to the scalp.

Some numbness over the forehead and scalp can also occur due to stretching of the nerves and this usually recovers within a few weeks.

A small amount of hair loss in the region of the incisions is very occasionally seen (2-3% of patients) although this recovers by itself over a period of time.

Endoscopic brow lift is an excellent operation for rejuvenating the forehead and lifting the brows to give an open appearance and fresh look to the upper third of the face which are characteristics of youth and beauty. By utilising keyhole techniques it has the advantage of leaving no visible scars. CSMUK