It is not surprising that cosmetic surgeons are often asked what is the difference between a brow lift and a forehead lift. After all, both descriptions involve the same area of the face, and both imply a lift. The brow is considered the hairy part right above the eyelids – the eyebrows, and the forehead is the area between the eyebrows and the scalp. Most patients, and even plastic surgeons, may use these terms interchangeably. Both of these terms describe a procedure intended to smooth and lift the skin of the forehead, and to lift and reposition the brows. How this works, however, is different for each of the areas.
In order to highlight these differences, it can be helpful to compare a brow lift or forehead lift to a facelift. When a facelift is performed, the pulled skin stretches fairly evenly, with the effect seen over the entire length of the face. It is similar to pulling a rubber band that is anchored on one end. In the forehead, however, the skin is thicker and less elastic. When the forehead is pulled, there is much less stretching of the skin.
In order to smooth and lift the skin of the brow/forehead, your surgeon will first gently create a separation between two of the tissue planes of the forehead, allowing them to glide on each other. Your surgeon will also release the attachments of the brows so that they can more freely be moved to the desired position, and then the tissues are then fixed in their new position.
So far, so good . . . but you may be asking, if the forehead skin is not stretched out very much, why do the wrinkles in the forehead get better? That is an interesting question, and the answer is equally interesting. The horizontal wrinkles in the forehead are not static – rather, they are dynamic. In other words they result from the activity of the underlying muscles that work to lift the brows. When the brows are lifted by surgery, then these muscles calm down and become less active because the stimulus to lift the brows is reduced. In addition, a brow/forehead lift often removes the muscles that are between the eyebrows. These muscles, called the corrugators, are the cause of the vertical wrinkles – also known as the “11s”. The corrugators and the muscles that lift the forehead tend to work against each other, so when the corrugators are weakened, the muscles that create the forehead wrinkles tend to work less, also helping the wrinkles to fade.
There are many different brow/forehead lift techniques that you and your cosmetic surgeon can consider depending on your individual needs. In most instances, an endoscopic approach allows for very small incisions hidden in the hairline. But there are some instances where an endoscopic approach can be combined with an incision in the eyelid performed along with an eyelid lift. And although not as common, an incision hidden along the hairline can actually lower the forehead while the brows are being raised in patients who have very high foreheads.
While we tend to use the terms brow lift and forehead lift synonymously, there are procedures where the brow is directly lifted but the forehead is not. A direct brow lift is rarely done, but works by removing a strip of skin along the upper border of the brows. This creates a scar in this area, however this technique can be used in the elderly as these scars may fade well. Another technique is to perform a browpexy, where sutures are placed using an eyelid incision to sew the undersurface of the brow to the bone. This can create a nice elevation of the brow, although it is less powerful than a full brow/forehead lift. As you can guess, this latter technique is most often combined with an upper eyelid lift.
The terms brow lift and forehead lift are used practically to describe the same thing. But what is more important than the terms, is the need to consult with your surgeon to make sure the strategies and techniques they use are best suited for your goals and anatomy. At the Emory Aesthetic Center, our multi-disciplinary team of board-certified physicians can help you navigate all the terms and decisions to come up with a treatment plan custom tailored just for you.
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About Dr. Eaves
Dr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.
His professional and institutional committee memberships and offices include an impressive list of national, international and local plastic surgery organizations, societies, boards, task forces, advisory councils, coalitions and foundations, including having served as President of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2010-2011 and Trustee (2011-Present).
Dr. Eaves’ primary areas of academic inquiry have been in minimally-invasive and endoscopic aesthetic surgery, patient safety, system and process improvement in plastic surgery, evidence-based medicine applied to plastic surgery and recontouring surgery after massive weight loss. He has received several patents for new medical devices he developed, and has made major clinical service contributions to his field. Dr. Eaves has published more than 100 articles, book chapters and book reviews on plastic surgery in peer reviewed publications, as well as manuals, videos, computer programs and other teaching aids and has coauthored the first textbook on the topic of endoscopic plastic surgery.