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Blepharoplasty Lady


September 19, 2016


What is a browlift?

A browlift is the surgical repositioning of the brow into a more aesthetically-pleasing position.  Typically, aesthetically pleasing brows have the outside, or tail, of the brow slightly higher than the inside, or medial aspect, of the brow.  With aging, the brow tends to droop and sag, leading to hooding, which is extra tissue on the upper lid and outer aspect of the brow.  Surgical repositioning of the brow into a more elevated position also takes with it mild to modest extra skin of the upper lid and can be combined with upper lid blepharoplasty.

There are two types of browlift.  A traditional browlift has an incision which goes from ear to ear through the top of the scalp, called a coronal browlift or open browlift.  This browlift is typically not performed as commonly in the modern era of aesthetic plastic surgery and is usually reserved for the heaviest of brows with very thick tissue that may not be able to be performed with more minimally-invasive browlift techniques.

The most common type of browlift performed in the modern era of aesthetic plastic surgery is an endoscopic or telescopic browlift where the brow can be repositioned surgically through two or more small one-inch ports placed strategically within the scalp hair.

Browlifting males typically differs from browlifting females.  Please see the section on male browlift surgery.

How is an endoscopic browlift performed?

The endoscopic browlift is performed by placing two small, two-centimetre, (one-inch) access ports vertically or horizontally in the lateral aspect of the brow hairline.  Through these small ports, a small telescope, also called an endoscope, is place and the entire browlift procedure is performed on a television camera.  The endoscopic approach allows elevation of the brow tissue right down to the eyebrow bone and the eyebrow itself.  Once the soft tissue is released, the muscles that pull the brow down and make the brow droopy are weakened, minimizing the ongoing need for Botox® Injectables and minimizing the ongoing tendency for these strong depressor muscles to cause recurrent brow ptosis or brow drooping.  Once the brow soft tissue is freed and the depressor, or pulling down, muscles are weakened, the brow is then elevated to the ideal position, which is visually assessed on both sides carefully prior to fixation.  The fixation is typically performed with a very small bio-absorbable fixation device called an endotine.  These small endotines hold the brow into position until the soft tissue of the brow sticks to the underlying bone, which occurs over several weeks.  The small endotine fixation device dissolves over 12 to 24 weeks.  Typically the scalp access ports are closed without through-and-through stitches with scalp clips and small drains are left in place to drain any fluid and help facilitate adherence of the brow soft tissue to the underlying frontal bone.  The drains are typically removed the following day and most patients having a browlift procedure can return home the day of the procedure.  The browlift may be combined with upper lid blepharoplasty, lower lid blepharoplasty and other cosmetic plastic surgery procedures.

Who is a candidate for the endoscopic browlift or browlift procedure?

Good candidates for browlift surgery are those candidates who exhibit drooping of the brow with inferior displacement and have realistic expectations around the aesthetic contours that can be achieved.  Good browlift and endoscopic browlift patients are medically well, have no underlying health issues and are accepting of the down time or recovery associated with the procedure.

What kind of anaesthesia is used to perform an endoscopic browlift or browlift surgery?

Most browlift surgery can be performed quite simply under local anaesthesia.  The local anaesthetic is used to block the nerves that supply sensation to the brow, rendering the brow and scalp completely anaesthetic.  Endoscopy and open browlift surgery is supported with oral sedation and the procedure takes approximately one hour to complete.  Those patients who are more anxious and desire not to be awake during the procedure may also have intravenous twilight sedation or general anaesthesia performed by s board certified anaesthesiologist.

Is an endoscopic browlift or browlift procedure painful?

The endoscopic and open browlift procedures have only a mild to moderate degree of discomfort during the recovery period .  The degree of discomfort is generally easily managed with non-steroidal anti-inflammatories and very mild pain-relieving medication.  There is a modest degree of swelling and bruising and most patients who have isolated endoscopic open browlifts can return to work in approximately seven days.  There is a period of modest numbness of the brow soft tissue, which generally returns over six to 12 weeks.

What is the recovery like following an endoscopic browlift or open browlift procedure?

The recovery following an endoscopic browlift or open browlift procedure is relatively simple.  The small clips hidden within the hair are removed within one week.  There is mild to moderate swelling and typically only mild, if any, bruising and this all resolves, usually within seven days.  If no other cosmetic facial procedures are performed, an endoscopic or open browlift combined with upper lid blepharoplasty, generally patients look socially acceptable within seven days and  can return to work within a seven-to-ten day period of time.  Low impact exercise and aerobic activities can begin in the second week with high impact exercise and aerobic activities within four to six weeks.  Sporting activities that require wearing a helmet can be resumed within six weeks.

How long does the endoscopic browlift take to perform?

An isolated endoscopic browlift can be performed in approximately one hour and Toronto browlift and endoscopic browlift patients can typically return home the same day.

What kind of results can I expect from my endoscopic or open browlift?

Toronto browlift patients can expect a very pleasing aesthetic repositioning and re-contouring of the entire brow.  A large portion of Dr. Mulholland’s aesthetic plastic surgery practice is focused on aesthetic elevation restoration of the brow, cheek, face and neck.  The brow is an elemental component of upper facial aesthetics and patients can expect that the aesthetic aspects of the brow, particularly the tail of the brow, or outer aspects of the brow will be repositioned in an aesthetically pleasing fashion.  It is very common to have the endoscopic browlift performed at the same time as an upper lid blepharoplasty and perform the endoscopic browlift, repositioning the tail of the brow, minimizes the extension of the upper blepharoplasty scar.   The before-and-after results of Dr. Mulholland’s endoscopic open browlift are very natural and pleasing and general provides a fresher, more youthful, less tired and beleaguered look to the face.  Dr. Mulholland’s aesthetic browlifts leave a patient looking refreshed, rested and natural, but not operated upon or unnatural.  It is never the goal of an endoscopic or open browlift to leave a patient looking startled or “a deer in the headlights” appearance.  Dr. Mulholland will show you the kind of brow elevation that should be performed to result in a very natural look at the time of your consultation.  Dr. Mulholland’s endoscopic browlift is a unique procedure that he has pioneered and allows him to reverse a brow that may have been elevated too high.  Although Dr. Mulholland has never had to lower a brow because it had been elevated too high, it is always reassuring to patients to know that this can be performed and that the brow elevation has a reversible component.

What are Dr. Mulholland’s endoscopic and open browlift patients saying?

Most endoscopic browlift patients with or without combined upper lid blepharoplasty are extremely happy with the results of their aesthetic facial procedure.  The procedure leaves patients looking rested and fresh and quite natural rather than tired and beleaguered that results from droopiness or sagginess of the brow and upper lid.  Performed naturally and expertly, Dr. Mulholland’s patients look fresh and youthful but not “done”.  Dr. Mulholland has performed his unique endoscopic browlift procedure on several television shows and the results of these procedures can be seen in the video on this content page, as well as the before-and-afters in the before-and-after gallery on this browlift content page.

How long will the results of my endoscopic and/or open browlift last?

The results of an endoscopic browlift typically will last between five and eight years.  Combined endoscopic browlift and upper lid blepharoplasty typically will last longer, preserving the fresh youthful look of the upper facial brow and eye region.  Patients who have very strong depressive activities of the facial muscles will be identified by Dr. Mulholland pre-operatively and these depressive effects pointed out.  Dr. Mulholland weakens by removing some of these depressive muscles; however, for all endoscopic browlift patients, it is recommended that ongoing Botox® Injectables to weaken the muscles of brow depression be undertaken.  Typically, Dr. Mulholland will use Botox® Injections pre-operatively so that the depressive muscles are not constantly pulling down the brow in the post-operative period, until it has healed.  Simple Botox® Injectables, generally performed twice a year, should help maintain the endoscopic brow and/or upper lid blepharoplasty for eight years or more.  Typically, within a decade, however,  a repeat endoscopic browlift needs to be performed.  This, again, can be performed under local anaesthesia in approximately an hour and the brow simply repositioned to its former elevated location.

Is there any maintenance required following my endoscopic or open browlift?

The maintenance required after endoscopic or open browlift surgery typically involves the use of Botox® Injections twice yearly to weaken the muscles that pull the brow down.  The Botox® Injectables will have the added benefit of minimizing lines and wrinkles of the upper brow and side of the eye, but the principal reason Botox® Injections would be deployed after your browlift is to weaken the muscles that pull the brow down, which will allow your browlift results to last much longer.  There is a post-operative complimentary program that is provided after your browlift surgery that works on lines or wrinkles and skin tightening of the upper face.  This fractional and bulk heating radiofrequency program is performed once a month for four to six months after your browlift surgery and is part of your browlift surgery fee.  The post-operative course will outline the type of procedures that you may need to perform in order to maintain a tight skin envelope of the lower, middle and upper face.  Many patients elect to go on a maintenance program of skin tightening or wrinkle reduction using fractional laser devices, intense pulsed light and non-ablative RF treatments once every three to four months.

How much will my endoscopic or open browlift surgery cost?

The cost associated with an endoscopic or open brow lift depends upon the degree of difficulty, the amount of brow ptosis, the heaviness of the tissues and the strength of the depressor muscles; but typically, endoscopic browlifts start as low as $4,999 and up and can be combined with upper or lower lid blepharoplasty or other associated procedures.

Why choose Dr. Mulholland and SpaMedica for my endoscopic browlift procedure?

Dr. Mulholland is one of Canada’s foremost plastic surgeons with a specialty training in head/neck oncology, ear/nose/throat cancer, craniofacial trauma and board certified in plastic surgery.  [This] makes Dr. Mulholland one of the best-trained head and neck facial aesthetic plastic surgeons in Canada.  He has a tremendous amount of experience with endoscopic and open browlift surgery over the past 20 years.  His unique development of the procedure has resulted in a reputation for extremely high-quality, fresh and natural upper facial, brow and lid rejuvenation.

How do I schedule a consultation with Dr. Mulholland for my endoscopic or upper browlift?

Toronto browlift patients interested in an endoscopic or open browlift, with or without upper lid surgery, can simply click on the e-mail consultation request form on this content page and/or call the number directly on this endoscopic browlift content page and a SpaMedica client service representative will schedule your browlift consultation with Dr. Mulholland.   Call now to achieve a natural, fresh look to the upper face, brow and eye region.


Dr. Stephen Mulholland, MD
Posted by Dr. Stephen Mulholland, MD
has been practicing plastic surgery for over 20 years. He is one of Canada’s most renowned and best plastic surgeons in Toronto with his wealth of experience, artistry, and humbleness towards his patients.

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