There are various approaches to lifting the brow, and the terms browlift and forehead lift are often used interchangeably.
Dr. Bentkover performs a number of different types of browlifts and forehead lifts. Sometimes, patients who think they need an upper eyelid blepharoplasty to remove excess upper eyelid skin actually are better served by having a browlift/forehead lift. Some patients may require a browlift/forehead lift and a blepharoplasty. Also, these procedures are often done at the same time as a facelift.
In a direct browlift the brow is lifted through an incision made along the upper edge of the eyebrow or sometimes in a wrinkle very close to the brow. In a mid forehead lift the incision is placed in a deep forehead crease in the middle of the forehead. Dr. Bentkover most commonly does these particular procedures on men whose hairlines are too high to hide the incisions of an endoscopic browlift or open forehead lift. A very deep crease in the middle of the forehead will hide an incision reasonably well, but Dr. Bentkover prefers to hide the incision in the hairline, if at all possible, with an endoscopic browlift or open forehead lift.
An endoscopic browlift (or endoscopic forehead lift) is performed through five small incisions hidden behind the hairline. Using a special sterile telescope called an endoscope, Dr. Bentkover can carefully identify and release the muscles which pull your brow down excessively. With an endoscopic browlift you can usually expect 3-5mm of elevation of the brow. The major advantage of the endoscopic approach is the small incisions and less post-operative numbness.
If you need more elevation of the brow, an open technique may be better for you. The open forehead lift uses an incision hidden behind the hairline that extends from ear to ear (coronal incision), an incision hidden at the front of the hairline (pre-trichal incision) or a wavy, zigzag incision hidden in the fine hair of the hairline (trichophytic incision). Your incision may also be a modification that combines one or more of these types of incisions. The advantage of an open forehead lift is that it can give more elevation of the brow than the endoscopic technique, often 5mm to 1cm of elevation. The principle disadvantage of the open technique is a longer period of numbness of the scalp after surgery and sometimes some permanent numbness of the scalp.
At your consultation, Dr. Bentkover will carefully evaluate the height of your brow and listen to your desires. He will recommend the procedure he feels will work best for you. Above all, he wants to make sure you will be happy with the result and not have a “surprised” look.
Often Dr. Bentkover will recommend combining a browlift or forehead lift with an upper eyelid blepharoplasty to remove excess skin that remains after the brow has been put in a better position. He likes to do the blepharoplasty as a secondary procedure under local anesthesia in our office operating room a few weeks to a few months after the browlift or forehead lift. In this way, he can better judge exactly how much skin needs to be removed from the upper eyelid.
Occasionally, your insurance company may pay for part or all of the cost of surgery if the procedure is performed to specifically improve impaired vision (as documented on a visual field test). If you think your vision is impaired by a low brow, you should have a visual field test performed in an ophthalmologist’s office prior to your consultation with Dr. Bentkover and bring a copy of that test with you to your consultation. Because coverage criteria vary among different insurance companies, it is recommended that you check with your own insurance company to determine the level of coverage and criteria for coverage prior to booking your consultation.
Our staff will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and medications. If you smoke, we will ask you to quit for at least two weeks before and after your surgery, since smoking may have an effect on how well you heal. You must stop all anticoagulant medications and herbal preparations such as aspirin, ibuprofen, vitamin E, gingko, St. John’s wart, garlic or ginseng 10 days prior to surgery . You may be required to take antibiotics to prevent infection. You should shampoo your hair the night before surgery.
Dr. Bentkover will carefully mark the amount of elevation of your brow that you and he have agreed upon. He will also mark the location of all the incisions needed for your procedure.
According to your wishes and Dr. Bentkover’s specific recommendations, he will perform a direct browlift, mid forehead lift, endoscopic forehead lift or open forehead lift. Each of these procedures is explained on the web page titled Procedures: Browlift & Forehead Lift/Overview.
A direct browlift is performed through an incision made along the upper edge of the eyebrow or sometimes in a wrinkle very close to the brow. Generally local anesthesia or local anesthesia with sedation is recommended.
A mid forehead lift is performed through an incision in a deep forehead crease in the middle of the forehead. Usually, local anesthesia with sedation or general anesthesia is recommended.
In an endoscopic browlift (or endoscopic forehead lift) he performs the surgery through five small incisions hidden behind the hairline using a special sterile telescope called an endoscope, Dr. Bentkover usually recommends general anesthesia for this procedure.
The open forehead lift uses an incision hidden behind the hairline that extends from ear to ear, an incision hidden at the front of the hairline, or a wavy, zigzag incision hidden in the fine hair of the hairline. The incision may also be a combination of one or more of these types of incisions. Dr. Bentkover usually recommends general anesthesia for an open forehead lift.
Surgery performed under local anesthesia may be performed in our office operating room in our suite at Worcester Medical Center, Worcester, MA or in our office in Stoneham, MA, whichever is more convenient for you. Procedures requiring intravenous sedation or general anesthesia are usually performed in the Day Surgery Unit at Saint Vincent Hospital in Worcester Medical Center, Worcester, MA. We are confident you will find all of these facilities to be state-of-the-art, comfortable and very patient friendly.
Recovery: What to expect
Dr. Bentkover may prescribe antibiotics for several days following surgery. Sutures are generally removed within 7-10 days. Swelling and some bruising are common and should subside within a few weeks. Ice is very helpful in minimizing the swelling and bruising. Women may use eye cosmetics one week after surgery.
Complications are rare but may include post-operative bleeding, persistent numbness, and asymmetry. If one brow is significantly lower than the other pre-operatively, it may be very difficult to get them equal with surgery.
You can proceed with your normal daily activities within 10 to 14 days but should put off weight training or other heavy lifting. Depending on how much bruising you have and how fast you are healing, Dr. Bentkover will advise you as to when you may resume activities like weight training, running, spinning, treadmill walking/running and elliptical training.
Dr. Bentkover will see you several times after surgery, taking final post operative photos at one year.
Dr. Bentkover does both procedures. His choice of procedure depends on the amount of elevation required and, sometimes, the age of the patient. He generally recommends endoscopic procedures to patients under 50. His ultimate decision, however, depends on your exam and your desires.
The swelling for endoscopic and open procedures is about the same. Of course, smokers generally swell more. In most cases you will have some eyelid swelling. Most of the black and blue and swelling is gone by 10-14 days.
Dr. Bentkover will make every effort to elevate your brow to an appropriate level. He does not want you to look surprised.