The effect of ageing on the face leads to loss of skin elasticity and support for the deeper facial structures. In the upper face, this can cause the brow to droop, and the frown lines of the forehead and those between the eyebrows to be more prominent making people look older than they really are.
A browlift is an operation to try and reverse the effects of ageing on the brow and so rejuvenate the forehead to make it look younger. It is often combined with a facelift and/or blepharoplasty surgery (eyelid reduction surgery). There are many different ways of performing a browlift operation. The operation usually takes between 1-2 hours to perform and is done either as a daycase procedure or else requiring 1 day in hospital. In its simplest form, the direct open browlift, it involves cutting away an ellipse of skin and muscle just above the eyebrow and stitching the wound closed with dissolving stitches. This can be very effective at elevating the eyebrow, but leaves a visible (albeit short) scar and cannot address the forehead frown lines. An indirect open brow lift involves either a long incision at the junction of hairline with the forehead, or an incision well behind the hairline which passes from the top of one ear across the scalp to the top of the other ear. Through these incisions (cuts), the skin and muscles of the forehead are reflected down and the muscles causing the deep frown lines are reduced. A rim of skin is excised from the edge of the incision so that when the wound is stitched, the eyebrows are elevated. The scalp wounds are then closed with dissolving stitches and the wounds are then covered with a bandage. For smaller elevations of the brow, for example about 5mm, an endoscopic browlift technique can be performed. This involves making 3-4 short vertical incisions (cuts) behind the hairline and passing a telescope connected to a camera through the incisions to show the surgery on a video monitor. Instruments are inserted through the other incisions allowing the muscles which cause the frown lines between the eyebrows to be reduced. The eyebrow is elevated by tightening the deeper layers of the scalp with stitches, but no skin is excised, and so a smaller elevation in the brow is possible with this technique compared with longer scar techniques. The advantages of an endoscopic browlift are that scars are small and can often be well hidden. The bruising and swelling may be reduced.