Risks associated with brow lift surgery may be grouped into anesthesia risks, and surgical complications. Anesthesia risks are common to any surgery and are discussed elsewhere. Events such as cardiac complications (heart attacks or myocardial infarctions), allergic or anaphylactic reactions, lung-related adverse effects (pulmonary embolism, pneumonia), kidney, liver, or any other organ system problem would all fall under that category. Complications related to the act of surgery may be grouped into risks involved in undergoing any procedure, and risks particular to brow-pexy, or brow lifting. Risks of any procedure include bleeding or hemorrhage, infection, whether skin, soft tissue, abscess, or necrotizing, acute and chronic pain, and acute or chronic skin sensitivity. Delayed healing is more common is persons with vascular disease and smokers. Fluid collections known as seroma may occur in the dissected space, this typically resolves with fluid drainage. Fine results are anticipated but never guaranteed. Dissatisfaction with the cosmetic outcome of any procedure will require procedural correction.
Complications related to brow lift surgery include asymmetry, which may need surgical correction through re-operation, inadequate correction of the low brow, over-correction of the brow leading to either a “surprised look,” or even an inability to close the lids (which may lead to its own problems with the cornea, tearing, dryness, etc. and is usually a result of a combination procedure with upper blepharoplasty – persistent symptoms of this nature may require surgical reconstruction). Alopecia, or hair-loss around the incision is not a frequent complication, but is not rare, and my necessitate hair replacement or re-positioning for correction. In some cases, the endoscopic brow lift approach must be changed to the open approach. This is dictated by factors unforeseen preoperatively, such as inadequate exposure, inadequate correction, uncontrollable bleeding, etc. Contour abnormalities, divots, lumps, bumps, wrinkles may result from a brow lift. This is caused by the dissection, or by the use of a fixation device. When presenting weeks after surgery, irregularities may be a result of internal scarring. They typically resolve without issue, but may need correction in some cases. Recurrence of the brow droop is also a common negative outcome in brow lift surgery, in which case the brows need to be re-positioned. Fixation devices, as a matter of a rare complication may also penetrate the skull, and cause intracranial bleeding and/or injury necessitating emergent treatment. Visible or “feel-able” hardware may need to be removed once a stable result has been achieved. “Dog ears” are more of a possibility with the open approach, and may also require secondary correction. Scars are not particular to the browpexy procedure, but their prominence, or asymmetry if present, after this procedure may be hard to mask, and may require revision brow lift surgery or other means of making the inconspicuous. Dissection in any brow lift whether open or endoscopic proceeds in a space that is close to sensory nerves which supply or give feeling to the front scalp, and the forehead. Cutting such nerves will result in loss of sensation to the innervated skin. This is much less common with the endoscopic approach, and is guaranteed to happen for the scalp skin in the back of the incision after the open or coronal approach. Sensation usually returns without a problem. Damage to nerves that innervate muscles of the face is also possible but rare.
