The brow lift is necessary when the eyebrows are too low giving the patient a tired, unhappy, or angry look. It was traditionally done through a coronal approach which necessitated an incision a few inches behind the hairline or if the hairline was too high, an incision in front of the hairline. The scalp behind the incision remained numb. In early 1990s we adopted the endoscopy in plastic surgery. I have been doing endoscopic brow lifts since 1993.  In the beginning, we freed the soft tissues of the forehead  from the underlying bone, lifted the brow up and maintained it by screws, and later by absorbable hooks  (Endotine). This was a lot less invasive and preserved the nerves to the scalp, but the longevity was not as good as the standard coronal lift. Today, I perform my brow lifts using a modification of the endoscopic procedures where I excise some skin from the upper lateral forehead where there is fuzzy hair, in order to eliminate some of the receding hair line and shorten the forehead in that area. This combination gives us the benefits of both conventional and the endoscopic procedure, but it eliminates the undesirable side effects. The small incisions heal so well that they are seldom visible even upon close inspection. If the anatomy is unfavorable or the patient has an objection to the small incisions, then I would use a different method of suspension.

The brow lift is often combined with a face lift or an upper blepharoplasty (eyelid surgery). This is to avoid crowding (excess) of the skin in the lateral orbital area which results occasionally from a face lift with more of a vertical vector (example a Short scar facelift or an S lift). Brow lift is also necessary for correction of the upper eyelid because when there is a lot of excess skin in the upper lid, the brow is by reflex elevated to absorb some of that skin. When a blepharoplasty is performed and the excess skin is removed the brow assumes a lower position, which could be less desirable. In fact as I alluded to it, a natural looking facial rejuvenation is one that establishes harmony of the entire face, but it is not necessarily less invasive or less surgery.

My procedure is normally performed under local anesthesia with conscious sedation. This reduces the incidence of nausea and vomiting and facilitates the healing process.

The patient is discharged with a head dressing, oral pain medication and an office appointment for the following day.It is recommended to keep the back elevated on pillows to help with the swelling. The sutures are removed in five days. If one leaves them in longer, they will cause white dots or tracks. The swelling and any bruising would subside within a week or two. There could be some temporary numbness and itching of the forehead and scalp.

I operate at Morristown Memorial Hospital, the Morristown Surgery Center next door to our office, or at the Florham Park Surgery Center. I feel that it is important to perform these procedures in a state of the art facility with good support even if the surgery is done under local anesthesia.