Interest in plastic surgery is at an all-time high, but stigma and misinformation still surround the industry and the patients. Welcome to Life in Plastic, a new series by Allure that aims to break down cosmetic procedures and provide all the information you'll need to make whatever decision is right for your body — no judgment, just the facts. Here, we're covering everything you need to know about the "mommy makeover."
Since the birth of Botox, interest in the surgical brow lift (aka forehead lift) has waned considerably, its popularity dropping 69 percent between 2000 and 2019, per the American Society of Plastic Surgeons. But suddenly, it seems, the procedure has captured the attention of a new generation, one far younger than the 50-something women who once dominated the demographics: millennials.
"It’s all because of Bella [Hadid]," board-certified Beverly Hills facial plastic surgeon Sagar Patel tells Allure. Indeed, the model’s unmistakable feline gaze could very well have inspired thousands of brow lifts in recent years, our experts concur.
In the Beverly Hills office of board-certified facial plastic surgeon Sarmela Sunder, "the most popular variation [of the procedure] is a lateral brow lift, or what I call a cat-eye brow lift, where I elevate the lateral third of the eyebrows, or the tails. Second to that is more of an overall brow lift — raising the eyebrows from the arch out to the tail — and that creates a peaked look more in line with that of Kylie Jenner or Gigi Hadid," she explains.
The pandemic has only fueled the trend. "With compulsory mask-wearing, there is more focus than ever before on the upper third of the face," says Lara Devgan, a board-certified plastic surgeon in New York City. Many of her patients largely desire "fuller brows with a classic lateral third arch" — much like what Sunder describes.
An Unconventional Choice
Perhaps more surprising than the age of these patients is their willingness to go under the knife for an effect that could be at least partially achieved with injectable neuromodulators (aka botulinum toxins), like Botox, Xeomin, Dysport, or Jeuveau. "Traditionally, that’s the route patients would take — try a chemical brow lift [with toxin] first, and if that doesn’t work, go for surgery — but a lot of millennials are already savvy to the surgical brow lift," says Sunder, noting that roughly 35 percent of her prospective brow-lift patients in their 20s and 30s go straight for the operation without ever experimenting with injectables. "From the patient’s point of view, they’re impatient with the idea of repeat treatments, and they like that immediate satisfaction and lasting results," she says. Sunder adds that "a decent number of this younger population" also turn to surgery when brow-targeted thread lifts fail them.
Interestingly, she notes, these patients don’t typically take a surgery-first approach to achieve other cosmetic goals: For fuller lips, they use fillers before signing on for a lip lift; to correct eye-area issues, noninvasives precede blepharoplasty. "But with the brow lift, there’s definitely a [relatively] larger population that comes in asking about surgery before trying nonsurgical options," Sunder says. "Perhaps the surgery itself is not as off-putting as others, because the incisions aren’t on the face but rather hidden [in the hair]," she theorizes.
Devgan has noticed a similar trend in her Park Avenue practice. While "many patients are doing a neuromodulator brow lift as a gateway to a more permanent solution," she sees about 20 percent of millennial brow-lift seekers jump straight to surgery. "I usually encourage them to at least attempt a chemical brow lift before graduating to a surgical one," she says. "I think when you’re a young millennial, you owe it to yourself to climb the plastic-surgical ladder — you don’t want to skip a rung — and for many patients, a little neuromodulator injected in the right way can not only prevent or correct wrinkles, but also take the place of a surgical brow lift. Of course, for certain people, it won’t lift enough to make them happy, and in those situations a temporal [or lateral] brow lift can give a really nice improvement in arch and more of that cat-eye look that has been so popularized by Bella and Kendall."
Why the Millennial Lift Is Raising Eyebrows
Despite the reported boom, plenty of plastic surgeons have reservations about brow-lifting young patients purely for aesthetic reasons—versus, say, to fix a vision-obstructing congenital lid deformity—since all surgery comes with risk and carries lasting consequences.
There’s also an argument to be made against "getting surgery for a trend," says Patel. Yet, in the case of the lateral brow lift, some doctors insist that the desired effect actually is quite timeless, despite its poster girls having an otherwise of-the-moment look. "According to textbook aesthetics, the ideal eyebrow arch is located halfway between the outer edge of the iris and the outer corner of the eye — that’s a super-classic Cindy Crawford kind of look," notes Devgan. Sunder, too, believes this specific shape holds a sort of perennial appeal: "Look at actresses from the 20s and 30s — the elevated brow has always been in vogue," she says.
And the surgery itself, when performed appropriately and conservatively, "is very benign, and people tend to tolerate it really well," explains Devgan. "There’s minimal disruption of the normal tissue planes, and minimal, if any, tissue is removed. We’re not doing anything that’s leaving a major aftershock.” The only potential pitfall she foresees is that “some [patients] will experience age-related hair loss in a way that’s not totally predictable when they’re young. And if they do get a little post-menopausal thinning, is that going to make their incisions more visible?" This hypothetical risk is something she considers when planning incision locations for those who do go ahead with the procedure.
Chemical vs. Surgical: What’s Right For You?
If you’re still reading, we’re going to assume you’re at least a little bit curious about tweaking your brows via medical means. So, let’s take a closer look at the options.
If you elect a chemical brow lift...
Expectation management is key — grasping the nuts-and-bolts of the procedure and the myriad effects it can (and cannot) achieve. "The chemical brow lift is misunderstood: People think it can literally lift the muscles up," says Devgan. But in actuality, she explains, neurotoxin allows you to selectively turn down the activity of the muscles. "If you turn some down a little, some down a lot, some down not at all — and you do it in the right way with a good understanding of facial anatomy — you can improve eyebrow position." Depending on the patient, that could mean greater symmetry, higher peaks, or more upswept tails.
These effects will not be dramatic, however. Whereas surgery can lift the brows upwards of about one centimeter, "the chemical brow lift is a more limited procedure," explains Devgan. "It’s difficult to get more than a two- to three-millimeter elevation of the lateral brow using neuromodulator alone." And, of course, these gains are only temporary, as toxins generally last three to four months on average.
During your appointment, your injector may have you squeeze your eyes shut tight to find the greatest points of tension in and around your brows. In addition to hitting those spots, they’ll likely inject lateral to the eye and along the corrugator muscle in between the eyebrows, thereby weakening the muscles responsible for pulling the brows down, which allows them to rise up.
Choose an injector with a medical background, loads of experience, an artistic eye, and sound judgement. "Because when a Botox brow lift goes wrong, you can end up with asymmetry or a Spock eyebrow or a really angry look," says Devgan. And there’s no reversing it; you simply have to wait out the weirdness while the toxin’s effects gradually fade.
Echoing Devgan’s earlier point, Sunder adds, "Toxin can only elevate the brow to the level it’s naturally meant to rest at — it’s not going to lift any higher than your anatomy will allow." But injectors can sometimes eke out a hint more height by building up the eyebrows’ foundation with a brawny hyaluronic acid filler, like Restylane, placed deep on the bone. "By injecting above and/or below the eyebrow, we can fill out that whole area, expanding the compartment and effectively pushing it forward to lift the brow," explains Jason Bloom, a board-certified facial plastic surgeon based in Philadelphia. He often volumizes the temples and lateral brows together, as rounding out sunken temples helps to raise up and support the tails of the brows.
As for the cost? A chemical brow lift with neurotoxin will set you back between $500 and $1,200. If you choose to incorporate filler, figure in another $1,200 to $3,600, depending on the type and quantity of product needed. Prices for cosmetic procedures — both noninvasive and surgical — are always rather sweeping, because they’re largely based on each individual patient’s needs and desires, and their chosen provider’s level of expertise and geographical locale.
If you’re considering a surgical brow lift...
Book a consultation with a board-certified plastic surgeon, facial plastic surgeon, or oculoplastic surgeon to find out if you’re a candidate for surgery and discuss all of the risks and benefits.
A lateral or temporal brow lift can be performed under IV sedation or general anesthesia, usually in under an hour. While surgical techniques vary according to the doctor’s preference and patient’s needs, the procedure typically starts with the surgeon making two tiny incisions a few centimeters back from the hairline, one behind each temple, "at approximately the position of the idealized eyebrow arch," explains Devgan. They will then insert an instrument with which to dissect down through the scalp layers, freeing up all of the tissue in the area between the incision site and the top of the eyebrow, from the middle of the pupil over to the tail of the brow. Some doctors also enlist an endoscope for visual guidance.
"Regardless of a patient’s age, it’s critical to release the brow at a level below the periosteum, which is a Saran Wrap-like layer immediately above the bone," notes Sunder. "If we don’t adequately raise that level, the brow will drop back down pretty quickly."
In younger patients with little to no laxity, doctors rarely remove skin during a brow lift. In those over 40, they may trim out a small crescent of scalp before repositioning and tacking up the tissue with suture anchors or heavy braided stitches. "Depending on the placement of suture, you can change the way you orient the tissues," Devgan explains. "If you place your sutures more toward the center, you can get more of a peak. If you place them more lateral, you can get more of a cat-eye."
Following surgery, plan on being out of commission for five to seven days. You’ll have bruising and swelling around the incision sites and possibly above your eyebrows. Your doctor may have you wear a compression dressing for a couple of days, and will give you an antibiotic ointment to help your incisions heal faster. Post-op pain can usually be managed with Tylenol if needed rather than narcotics. Sutures, depending on the type, will either gradually dissolve on their own or be removed about a week after surgery. Expect numbness around your scars to last for several months, says Sunder; occasionally, this lack of sensation can be permanent.
Potential complications include bleeding, infection, hematoma (pooling of blood under the skin), wound separation, and poor healing. Hair loss at the incision site can also happen. "It’s rare that we have this issue, but if someone feels [they’re] at high-risk for hair loss, we’ll inject PRP [platelet-rich plasma] at the time of surgery [to stimulate the follicles]," Sunder says. Nerve injury is another uncommon risk associated with the brow lift, as "the frontal branch of the facial nerve which innervates the frontalis muscle [of the forehead] typically passes above the tail of the eyebrow," she adds.
Defying surgery’s reputed permanence, brow-lift results aren’t forever — more like a decade, max, often less in younger patients, since surgeons intentionally take a less aggressive approach, avoiding skin removal and taut tugging for a mere fine-tuning of the brow architecture.
Your anatomy, the complexity of the procedure, and your surgeon’s location and creds will all influence the final price tag, but you’re looking at a ballpark range of $4,000 to $16,000 for a lateral lift.
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Originally Appeared on Allure