Brow Lifting

Upper lid blepharoplasty and browlift by Dr Hodgkinson
Upper lid blepharoplasty and browlift by Dr Hodgkinson
Upper and lower blepharoplasty and browlift by Dr Hodgkinson
Upper and lower blepharoplasty and browlift by Dr Hodgkinson

Sydney plastic surgeon Dr Darryl Hodgkinson says brow lifting is the essential component of upper face rejuvenation.

Most people are surprised to know that 80 percent of facial expression comes from the upper third of the face. Our emotions are imprinted on this area – around the eyes, between and underneath the eyes and on the brow.

Eyelid surgery and brow lifting are complementary procedures. It is important to identify the drooping component of a brow rather than attribute all sagging only to the skin in the upper eyelid.

A less experienced surgeon might try to correct the eyelids solely with excessive resection of the skin, which can then create ophthalmological problems and a startled look, when in fact it was the brow that had descended.

The usual appearance of the descended brow is that the patient has aged and appears stern or unhappy. The horizontal wrinkles that appear across the forehead can also be disconcerting, especially for women, and as the eye frame shrinks patients complain of their eyes looking too small.

Although anti-wrinkle injections are helpful in readjusting the positions of the eyebrows, this non-surgical procedure can only achieve millimetres in lift; patients can end up spending a lot of money and achieve sub-standard results if a brow lift is what is actually required. Similarly, fillers used to improve wrinkles are also temporary and do not elevate the tissues like a brow lift to open up the eyes and alleviate a tired or angry look.

I have been performing brow lifts for 30 years, and since 1994 have nearly exclusively performed the endoscopic brow lift, which is a ‘Band-Aid’ style of surgery. It involves making small incisions in the hairline, thereby avoiding any loss of hair formerly associated with long-scar brow lifting.

By dissecting and teasing out the heavy muscles on the forehead, we can lift the forehead and fix it to a much more appealing, attractive position. This restores the arch of the eyebrow, as well as reducing the heavy wrinkling in the forehead and reduces the intensity of the frowning muscles and Crow’s feet.

The surgery must be performed artistically, so that the patient has a pleasant, desirable, non-stressed, youthful look rather than ending up with a startled or ‘rabbit in a spotlight’ appearance.

Balance is the key. For this reason, I get patients to bring in photographs of how their eyelids and brows looked when they were in their early 30s. We try to adjust the eyebrows and eyelids to a more youthful, attractive appearance which they had decades before.

The operation involves some discomfort and takes about a week to 10 days for most of the swelling and all the bruising to disappear. The brow lift incisions in the hairline are hidden but the special sutures which are used to hold up the brow, known as ‘Endotines’, take up to six months to dissolve. The main purpose of these highly specialised sutures is to secure the fixation of the brow in its new, rejuvenated position.

Two examples of recent brow lifts and eyelid combination surgeries are shown.