Brow lift scar is one of the main concerns of patients who seek surgery to correct the appearance of their sagging brow or forehead. While scar is an inevitable tradeoff, a good surgeon will make every effort to position it in hidden areas, says Beverly Hills plastic surgeon Dr. Tarick Smiley.
Dr. Smiley says that one of the most influential factors affecting the final appearance of brow lift scar is the incision technique and placement.
The scar from this hairline incision brow lift technique is expected to blend into the background.
In the past, most brow lifts were performed by creating an ear-to-ear incision that ran across the top of the head.
While the scar is placed behind the hairline, this antiquated technique ultimately raises the hairline to about an inch, which can lead to unnatural appearance particularly in patients with a high forehead.
Due to the inherent problems of the antiquated brow lift technique, Dr. Smiley says that he prefers the hairline incision method, or medically referred to as trichophytic.
The hairline incision causes no direct hair loss and removes only the excess skin from the forehead (instead from the scalp). The incision generally fades into a thin and undetectable scar, provided that proper wound closure has been used during surgery.
Instead of using one long straight incision, Dr. Smiley says a serrated incision (or zigzag) technique is more ideal during a hairline incision brow lift because it allows for good wound closure—i.e., no tension on the skin and so the scar generally fades nicely after a few months.
Furthermore, the serrated incision technique allows the hair to regrow naturally.
While the surgeon’s skillset, particularly involving his wound closure technique, plays a critical role in the appearance of brow lift scar, the patient’s commitment to recovery will also influence the final result. The consensus is to avoid sun exposure for a minimum of six months to prevent hyperpigmentation.
Hyperpigmentation happens when the scar darkens permanently after being exposed to UV rays. Hence, the use of protective clothing (e.g., large brimmed hat) and sunscreen is crucial to promote the most favorable scar possible (i.e., it blends into the background).
Many patients are also encouraged to use scar creams and other topical treatments containing silicone, which is known for its hydrating effects. A scar that heals in a moist environment is known to fade into the background.
Generally speaking, after a brow lift patients should expect 1-2 weeks of social downtime, i.e., no outward sign of the surgery.
Brow lift results are supposed to look natural—i.e., there is no visible scar, the brows are positioned and reshaped based on critical factors such as gender and facial features, and the skin appears smooth with no or very minimal creases.
The traditional technique uses a long incision about 2-3 inches behind the hairline that goes from ear to ear. It allows the surgeon to remove a small piece of skin to correct the sagging appearance of the forehead and brow, eliminate the muscle tissue that is causing the creases, and reshape and reposition the brows.
But for additional support, experts at the California Surgical Institute suggest the use of fixation devices to re-suspend the forehead tissue and brow muscles. Some surgeons use Endotine (which is an absorbable prong-like device), permanent or absorbable sutures, or screws.
Endotine is particularly popular in Los Angeles plastic surgery due to its impressive safety record. This absorbable device has multiple prongs that secure the forehead tissue to the small hole in the forehead bone.
Before the body absorbs completely the Endotine system, a strong muscle adhesion is created between the brow tissue and the forehead bone. Hence, the results are perceived to be longer and more stable as compared to brow lift without any fixation device.
One of the disadvantages of this device is that it can be felt through the skin, at least temporarily. Also, it is a little more expensive than the other fixation devices.
Other surgeons prefer the use of permanent sutures to re-suspend the brow muscle and forehead tissue suggesting that this technique provides stronger support than Endotine and absorbable stitches.
Despite varying views on which provides the strongest support among the fixation devices, the truth is that the surgeon’s qualifications—i.e., board certifications, training, and experience—are more critical factors than his preferred “technologies” and techniques.
It is important to note that good brow lift results are primarily achieved by a high level of technical skills combined with artistic competence on the surgeon’s part. In addition, it is of critical importance that he understands the nuances between male and female surgeries and the gender-based ideals of beauty.
Medical literature suggests that the longevity of brow lift results greatly varies from patient to patient (3-10 years) not just because of the techniques utilized at the time of surgery. Skin elasticity, sun exposure, skin care regimen, diet, and smoking will all have their effects as well.
Brow lift for high forehead must use specific techniques to prevent further elevating the hairline. For this reason the standard method does not work for patients with such “feature.”
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says the coronal brow lift, which is today’s gold standard, uses an incision that runs from ear to ear across the top of the head. While the technique provides the most elevation by removing the excess skin from the hair-bearing area, it ultimately raises the patient’s hairline to about half an inch.
Fortunately, newer brow lift techniques eliminate this key disadvantage, says Dr. Smiley.
In one of his Snapchat videos, he has demonstrated a modified technique of the coronal brow lift. Instead of placing the incision behind the scalp, he positioned it precisely at the hairline so the resulting scar is perfectly concealed by the hairline-forehead junction.
The aforementioned technique is called trichophytic and it removes the excess skin from the forehead, causing no direct hair loss. And if needed, the surgeon can also move forward the hairline; hence, it is also a good procedure in patients seeking revision brow to correct over-elevation created during the initial surgery.
Aside from proper scar placement, Dr. Smiley highlights the importance of using a serrated incision pattern (it resembles small Vs connected to each other), as opposed to a straight one, during trichophytic technique. This technique not only promotes “favorable” scarring but also allows the hair to regrow naturally.
To further conceal the scar that is positioned precisely at the forehead-hairline junction, Dr. Smiley says there should be no or very little tension on the skin. For this reason he always closes the wound in several layers, with the deepest having the most tension, which gradually decreases as they reach the skin surface.
In the video, he says that without tension on the skin, the scar tends to heal better and fade quicker.
Another possible way to perform brow lift for high forehead is to use an endoscopic technique. Four to five small incisions behind the hairline are usually created in order to insert an endoscope or tiny camera so the surgeon can see the underlying anatomy.
However, the endoscopic brow lift only has a minimal lifting effect because it does not remove any loose skin, i.e., it only elevates the forehead through internal fixation. For this reason it is generally suitable for younger patients aged between 30s and 40s.
Brow lift uses incisions behind the scalp or in front of the hairline to lift the sagging brow, soften the forehead creases, and eliminate the “11” lines between the brows. Occasionally, it is combined with other procedures such as eyelid lift and dermal filler or fat graft injection for additional rejuvenating effects.
Experts at the California Surgical Institute provide a list of brow lift FAQ to help patients decide if the surgery is right for them.
Brow Lift FAQ:
- Question: Am I a good candidate for the surgery?
Answer: The ideal patients should be healthy, non-smoker, and have realistic goals and expectations. Hence, the surgery entails a strict patient selection process to avoid risks and to deliver satisfying results.
- Q: What are the preparations involved?
A: A good rule of thumb is to avoid blood-thinners (aspirin and some herbal supplements and vitamins) and tobacco products; and to achieve one’s optimal health through lifestyle changes and/or medications.
- Q: Does it result in visible scar?
A: While brow lift comes in several variations, all efforts are made to ensure that the resulting scars are behind the scalp or exactly along the hairline for their optimal concealment. Simply put, a properly executed procedure should not result in visible reminders of plastic surgery.
- Q: Is it possible to perform brow lift at the same time as other facial rejuvenation surgeries?
A: Yes. In fact, brow lift is routinely combined with eyelid lift, fat graft, or some type of facelift. Nevertheless, it remains in the patient’s best interest to keep the operation under six hours to minimize bleeding and surgical trauma.
- Q: What are the risks involved?
A: Poor healing, less than optimal scar appearance, residual sagging, surprised or unnatural look, infection, and bleeding are some of the risks. However, a board-certified plastic surgeon who performs the surgery on a regular basis can avoid or at least control these risks through proper patient selection, surgical execution, and close monitoring during the initial healing stage.
Serious complications are extremely rare when the surgery is performed by a qualified plastic surgeon.
- Q: How long is the recovery period?
A: Recovery differs from patient to patient; however, “social recovery” or looking presentable in public typically happens after 10-14 days.
- Q: Can Botox serve as a feasible alternative?
A: Yes, provided the patient only has mild brow descent and accepts that she will need 3-4 “touch-ups” every year. But for individuals who want longer lasting effects and/or have significant soft tissue laxity, brow lift remains a better method than any type of non-surgical procedure.
A brow lift forehead technique that uses a frontal hairline incision can provide impressive rejuvenating effects to the right patients, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
In the past, brow lifts were typically performed with an ear-to-ear incision placed in the scalp. While this technique can elevate the forehead/brow and soften the wrinkles, in patients with a high forehead this could aggravate such appearance, hence they look odd after surgery.
To help would-be patients understand the benefits of brow lift forehead technique via frontal incision, Dr. Smiley has released a YouTube video showing how the surgery is accomplished.
In the video, Dr. Smiley says the relatively new brow lift technique favors patients with a high forehead because it allows him to shorten it through skin reduction and/or scalp advancement.
Contrary to popular belief, placing the incision exactly at the hairline does not lead to more visible scarring. For optimal scar camouflage, Dr. Smiley says he prefers a “zigzag” pattern, as opposed to a straight one, as the wound heals better, thereby leading to “favorable” scars—i.e., they are very hard to detect even by the patients.
To further promote favorable scarring, Dr. Smiley employs suturing techniques in which there is very minimal tension on the wound, thus allowing it to heal better and fade into imperceptible scar.
With the brow lift forehead technique, the renowned plastic surgeon says he is able to release the brow and the entire forehead skin, including the area above the bridge of the nose. To achieve a more natural result, he highlights the importance of lifting the tissue more laterally, as opposed to a “straight up” elevation.
By focusing on the lateral aspect of the forehead, he can reshape the tail end of the brow, which tends to droop with advancing age. Nevertheless, he says brow lift is a surgery by millimeter in a sense that the amount of elevation must be very precise to avoid surgical stigmata such as startled expression or overly tight appearance.
Natural looking brow lift can be achieved with proper patient selection and surgical planning. Instead of just lifting the sagging brow, good surgeons know that reshaping it based on the underlying anatomies and gender is also critical to produce great results.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley says that botched or overdone brow lifts typically result from lifting the medial brow excessively, or elevating it despite that its original position is already acceptable.
According to several studies, the ideal medial brow position is at the level or slightly below the bony orbital rim especially in men who need to preserve their “heavy” and masculine brow appearance.
For most brow lift patients, only the lateral part of the brow or “tail end” is slightly elevated, leaving most of its parts to their original position, Dr. Smiley further explains.
Another parameter to produce natural looking brow lift results, he adds, is to consider the beauty ideals of men and women. For instance, feminine brows are generally accepted to appear more arched and higher at the tail end, while male brows are more horizontally oriented and have a shorter distance between the upper eye crease and the bottom part of the brow.
Should the patients need the “inside” of their brow to be elevated, it must be done in a very conservative manner to avoid the perennially startled appearance or the quizzical expression, says Dr. Smiley.
A good number of brow lift patients can benefit from minimally invasive procedures, which may involve 3-5 small incisions behind the hairline to reshape and elevate the drooping brow. Another viable option is to place two concealed scars in the temple area, a technique that only lifts the outer 1/3 of the brow.
Instead of brow lift, Dr. Smiley suggests that sometimes an upper eyelid lift is a better option, particularly if the patients’ aesthetic goal is to open up the eyes. In this procedure, a fine scar is placed within the natural eye crease to tighten the loose skin and possibly remove some excess fat.
Dr. Smiley believes that a good number of botched brow lifts were patients who did not need them in the first place and should have received an upper eyelid lift instead.
While Botox may produce some of the brow lift’s results—i.e., this non-surgical procedure can also reshape and elevate the brow—it requires regular maintenance that adds up to the cost, he says.