Treatment

Botulinum toxin injections can be used for cosmetic correction in mild cases but needs to be repeated regularly to maintain the effect. Surgery is the most effective way to correct a more significant brow ptosis. It may be combined with upper lid 
blepharoplasty (removal of the upper lid excess skin) where indicated at the same time. The procedure is usually performed under local anaesthetic as a day case procedure. 

Pre-Operatively
Certain medications may need to be discontinued prior to the procedure. Foods and supplements such as ginger, garlic, ginseng, gingko biloba and vitamin E should be avoided for two weeks prior to surgery since they may have a similar effect. On the day of surgery no make up should be warn. You may eat and drink as normal prior to your arrival.

Procedure
The skin to be removed will be marked in a sitting position. The incisions may be made just above the eyebrows or in the hairline (the location will depend on your individual clinical case and will be discussed with you beforehand). Injections of local anaesthetic will be administered following the marking. The injections sting 
momentarily bur are very effective at preventing discomfort during the procedure. 

Absorbable stitches will be placed and a dressing applied at the end of the procedure. It is preferable to leave the dressing on at least one side overnight if possible.

Post-Operative care
Take regular simple painkillers (paracetamol 1g 4 times daily and/or ibuprofen 400mg 3 times daily with food). Apply a cold compress (bag of frozen peas or an ice pack) 5 x daily for the first 3 days.

Use additional pillows to raise your head above chest level overnight to discourage further swelling. Clean your face using a clean, damp flannel or cotton wool pads; avoid immersing 
your face in water. 

 

What To Expect Post-Operatively
In the first few days there is likely to be significant bruising, tenderness and swelling of the eyelids and cheeks. The eyelids may be difficult to open and/or close and vision may be blurred.
The skin stitches will start to fall away around 2-3 week; the deeper stitches take several months and sometimes as they break up they may emerge through the wound. This is nothing to worry about and you may remove them as they do so if you wish. The brow may relax down in the months/years following surgery, so is often overcorrected at the time of surgery to allow for this. The procedure can usually repeated in future years using the same scar, if necessary.

 

Wound Care
The wound will appear pink for several months but ultimately will form a curved line. For best results it is important to use sunblock every day from when the stitches fall out to prevent pigmentary irregularity in the area. Massage several times daily will help to make the scar as discrete as possible. Unfortunately it is not possible to do this surgery without leaving a scar. Silicone gel (Kelocote) during the day and/or silicone tape at night is really helpful to reduce the ultimate scarring. Petroleum jelly (Vaseline) is a cheaper alternative.

Risks
Bruising and swelling should be expected. 

​

Infection: The risk of post-operative infection is low. It is important not to allow the stitches to get wet, so do not immerse or splash your face with water. Use baby wipes or a clean, damp flannel to cleanse your face. If you need to clean away any debris from the wound(s), use cooled, boiled water and clean cotton wool pads.

Numbness of the forehead: This is rare and all precautions will be taken to avoid it.

Scarring: A direct brow lift leaves a scar above the eyebrow which is a cosmetically sensitive area. The visibility of the scar can be reduced with the measures detailed above.

Failure to meet expectations: It is not always possible to achieve complete symmetry due to anatomical constraints.

Please feel free to ask any questions you may have at any point prior to the procedure.