FOREHEAD LIFT / BROW LIFT

About Forehead Lift / Brow Lift

As we age gravity can affect our facial features in a variety of ways. Many of these changes are dependent not only on gravity, but also environment (sun damage), diet, genetics and the stress of our daily lives. The brow region can age prematurely creating fullness in the upper eyelid region as the brow descends or droops. In addition, deep lines and wrinkles can appear between the eyes and across the forehead related to underlying muscle activity, squinting or inadvertently trying to lift a drooping brow using the forehead muscles. For some people strong muscles between the eyes can create deep wrinkles that can lead to and angry appearance. Regardless of the underlying concern, a Brow Lifting procedure can restore youthfulness to the upper potion of the face in a natural and refreshed manner.

We have all seen celebrities or friends who have undergone a Brow Lifting procedure only to look worse than they did before with a surprised or scared appearance. This is NOT the goal of a Brow Lift. A Brow Lift should create a gentle arch to the eyebrow in women, gently opening the eye to create a refreshed and rested appearance. Sometimes the muscles between the eyes can be weakened or removed to smooth the forehead between the eyes and remove an “angry appearance”. In men, the brow can be lifted without arching the eyebrow taking years of aging away from the forehead and upper eyelid region. For men and women of all ages, a Brow Lift can tastefully and subtly improve the appearance of the forehead and upper eyelid region.

Is A Brow Lift Right For Me?

Brow Lifts can be performed for a variety of reasons. The first and most obvious is to lift the eyebrows to a higher position. As we age, eyebrows tend to drop below the level of the bone above the eye, causing a frowned and angry appearance. In some people, the fullness that is created in the upper eyelids by this lower brow position can actually impair vision.

The Brow Lift also can correct the vertical furrows or wrinkles that occurbetween the eyebrows and the horizontal furrows that occuron the forehead. These furrows result from muscle activity and surgery allows for partial cutting of the muscles to relieve the depth of the furrows. The shape of the eyebrow differs in men and women and this difference is maintained even though the brow is lifted to a new and more youthful position.

Brow Lift Options

Unlike many other areas of cosmetic surgery there are really only two types of Brow Lifts: Open and Endoscopic. The differences between these two techniques are primarily related to the length of the incision (scar), longevity and potential side effects such as numbness of the scalp.

OPEN BROW LIFT

An Open Brow Lift is performed either through an incision just behind thefirst row of hair follicles within the forehead hairline or farther back into the scalp. Regardless of the exact incision location, these incisions are carried across the scalp region parallel to the hairline ending within the hairline above the temple region. This approach to brow rejuvenation allows the removal of extra skin, tightening of the brow region lifting the brow to an appropriate and youthful position. The muscles of the brow can be weakened or removed through this approach including the muscles that create horizontal wrinkles across the forehead as well as the muscles between the brow region that contribute to the vertical wrinkles between the eyes.

Because this approach disrupts sensory nerves to the scalp, numbness of the scalp behind the incision can be experienced by patients undergoing an Open Brow Lift. Any incision within the scalp can cause thinning of the hair immediately adjacent to the incision. The longevity of an Open Brow Lift is generally thought to be greater than an Endoscopic approach due to the ability to better fixate the brow in its new position using the longer incision. The incision is usually closed with sutures or surgical clips that are removed approximately 7-10 days after surgery.

ENDOSCOPIC BROW LIFT

Using 3 to 5 small incisions, within the hair bearing portion of the scalp, a special operating “scope” is inserted beneath the skin of the forehead region allowing the surgeon to visualize the surgical site using a video signal displayed on a monitor inside the operating room. This approach allows precise visualization and positioning of the brow. It also permits direct visualization of the muscles that are sometimes removed from between the brows in order to soften wrinkles in this area.

This approach results in short scars within the scalp itself and less permanent numbness of the scalp. However, because the brow is fixated in its new position using shorter incisions the longevity of an Endoscopic Brow Lift is usually shorter than an Open Brow Lift. Sutures or surgical clips are removed approximately 7-10 days after surgery.

INCISION TYPES
Endoscopic Brow Lift		Open Brow Lift

Preparing For Surgery

At least 1 month prior to surgery
Stop smoking at least 1 month prior to your procedure to reduce the risk of postoperative cough and possible bleeding. Smoking reduces circulation to the skin, impedes healing, and can lead to major postoperative complications.

2 weeks prior to surgery
Stop all medications that can thin the blood at least 2 weeks prior to surgery. This includes drugs such as Aspirin, Coumadin, Lovenox, Ibuprofen, Vitamin E, and multiple herbal preparations. These medications may cause bleeding during and after surgery. If you need pain medicine during the 2 weeks prior to surgery you may use Tylenol.

1 week prior to surgery
Report any signs of a cold or infection that appear the week prior to your surgery. You may need to postpone your procedure to avoid unnecessary complications.

The day before surgery
Do not eat or drink anything after midnight before your surgery. This includes water, ice, or hard candy. The only exception is that you should take your blood pressure or heart medication with a sip of water the morning of surgery.

The day of surgery
Plan to wear comfortable clothes to the procedure. Wear a button down top so it does not have to be put over your head.

Do not wear jewelry or bring valuables with you on the day of surgery.

You may wash your surgical site with regular soap the day before and morning of surgery.

Do not wear cream or makeup on your face the day of surgery.

You must arrange to have a responsible adult drive you home after your procedure.

What To Expect On The Day Of Surgery.

When you arrive, you will be escorted to a preoperative evaluation area where you will be asked to change into a gown and will be given foot covers. Your surgeon and the anesthesiologist will meet with you before you enter the operating room suite. During this time, the surgical consent form will be reviewed with you in detail and special markings may be made on your skin at the surgical site. You will have the opportunity to ask any last minute questions.

Once in the operating room, you will be transferred to our padded operating room table. A nurse will start an intravenous drip in your arm and connect you to monitoring devices. The anesthesiologist will give you medication through your intravenous drip to make you feel drowsy.

When your surgery is completed and your dressings are in place, you will be moved to the recovery room. During this period a recovery room nurse will assure your comfort and continue to monitor you closely.

Your stay in the recovery room will last approximately 1 to 1 1/2 hours. Most patients are fully awake within 30 to 60 minutes after their surgery, but may not remember much about their time in the recovery room due to some of the anesthesia medication. Once you are ready for discharge, a postoperative appointment will be scheduled and your discharge instructions will be reviewed.

You must have a responsible adult drive you home from the surgery center. A responsible adult must stay with you the first night after your surgery because you have been sedated.

Post-operative Instructions

Diet: Start with clear liquids and toast or crackers. If those are well tolerated, progress to a regular diet.

Driving: No driving is permitted for the first week or while taking pain medicine. Make sure the swelling of your eyelids and/or has sufficiently resolved for you to see clearly.

Activity: After surgery you may engage in light activity such as walking. No bending, straining, or lifting anything heavier than a gallon of milk for the first 4 weeks. After 6 weeks you may resume more strenuous aerobic work and lifting activities.

Work: Depending on your career and your rate of healing you should be able to return to work within 1-2 weeks of surgery. Your surgeon will be able to give you a better estimate depending on you physical and professional profile.

Wound Care: Apply cool compresses to your eyelids and brows for the first 48 to 72 hours as this will help reduce pain and minimize swelling. Place a gauze pad or clean wash cloth into ice water, wring out the water, and place the compress over the area. Do not use a warm or hot compress until cleared by your doctor in clinic. Occasionally, a small drainage tube will be placed beneath the brow region to assist in the removal of swelling and bruising during the first 1-2 days after surgery. This tube is usually removed painlessly in the first two days after surgery. A dressing and head wrap will be placed at the time of surgery. Your surgeon will instruct you regarding the removal of this dressing.

Swelling and Discoloration: Moderate swelling and black and blue discoloration around the surgical site should be expected during the first several weeks. To minimize swelling keep your head higher than your heart at all times. Sleep with your head and shoulders elevated at a 45-degree angle for the first week.

Bathing: You may shower and wash your hair 48 hours after surgery if your surgeon has removed the surgical dressing. It is important to be gentle when washing your hair and to wash from back to front pushing hair forward TOWARDS the brow region. This technique of hair washing will help to prevent disrupting the fixation of the brow from its new location. Dry off with a towel and use a COOL setting on the blow dryer. Do not submerge the incision in a bath or swimming pool for 4 to 6 weeks.

Medications: Ask you surgeon when you may resume blood-thinning medications. All other prescription medications may be resumed immediately, as usual. While you are taking pain medicine, you are encouraged to follow a high fiber diet or take a stool softener such as Colace (available over the counter), as pain medications tend to cause constipation. You will be given a prescription for antibiotics, please take the full course as directed.

Smoking and Alcohol: Do not smoke for the first several weeks after surgery as it impedes wound healing and can lead to serious wound complications. Smoking also promotes cough, which increases your risk of bleeding. Alcohol consumption is dangerous while taking pain medicine as it has a tendency to worsen bleeding.

Makeup: Do not wear any eye makeup until your surgeon has told you that your incisions are healed, and gives you permission to wear makeup again.

Sun Exposure: If new scars are exposed to the sun, they will tend to become darker and take longer to fade. Make sure you wear a high SPF sunscreen with UVA and UVB protection and or a brimmed hat for the first 6 months after surgery.

Post-operative Appointment: Your first follow-up appointment will be 24 to 48 hours after surgery. Your surgeon will then schedule additional visits at frequent intervals to closely follow your healing process.

Special Considerations: Call your surgeon immediately if you experience any of the following: severe pain not relieved by pain medicine, marked swelling, significant visual changes (anything more than mild blurring), or fever over 101 F, chest pain, shortness of breath, or any other concerning symptoms.

Surgical Risks

All surgical procedures involve some risks including: the effects of anesthesia, bleeding, infection, pain, and swelling. There are also several possible complications specific to Browlifts that occur in a very small percent of people. After reading the discussion below, please contact your surgeon if you have any remaining questions.

Bleeding: Bleeding is usually minimal and well controlled during the operation.

Hematoma: A hematoma is a collection of blood under the skin. Hematomas typically develop within the first few days after surgery. However, they can occur at anytime after injury to the surgical site. The body can absorb small hematomas. Larger ones require the placement of surgical drains for optimal healing.

Infection: Antibiotics will be given to you prophylactically before surgery and for several days after surgery to minimize the risk of infection. If an infection does develop, it typically can be treated with different antibiotics. In some situations, surgical debridement (removal of the infected tissue) may be required. This can initially result in a larger scar, which may be revised at a later date.

Scarring: All new scars are red, dark pink, or purple. Scars of the face usually fade as they mature within 3 to 6 months. Our objective is to make them as inconspicuous as possible. In some cases broad or raised scars (keloids) develop. After the healing process is complete these can be revised. Scars within the scalp can result in thinning of the hair immediately overlying and adjacent to the scar.

Symmetry: Perfect symmetry is rare in nature. There may be some asymmetry between the brows. If asymmetry is pronounced or unacceptable to the patient, surgical revision may be performed.

Pain: Mild to moderate pain and discomfort is expected after surgery. You will be given a prescription for pain medication. If you have severe pain not relieved by pain medicine, contact your surgeon immediately.

Delayed Wound Healing or Wound Separation: Several factors can help decrease the risk of poor wound healing or wound separation: good nutritional status, a competent immune system, and not smoking for several months around the time of surgery.

Numbness: Any Browlifting procedure can result in temporary or permanent numbness of portions of the scalp. As discussed above, the amount of numbness is largely dependent on the technique used (Open vs. Endoscopic). It is normal for numbness of the scalp to be present to some degree in all patients during the first few weeks – months after surgery.