Brow Lift

Many patients want to eliminate a tired or “angry” look in the brow area. Some want to elevate a “saggy” eyebrow over the upper eyelids and improve sagging in the lower eyelids. Other patients want to lower or maintain the same brow position but eliminate the frown lines between the eyes. Most of all, patients that want improvement in the brow area want to be reassured that they will not have a “surprised look.”

An endoscopic browlift is performed to restore a more naturally youthful appearance and less fatigued look while maintaining or improving visual function. Once thought a beauty procedure sought by only wealthy women, men in today’s competitive corporate workplace are increasingly seeking browlift to restore a younger look that softens frown lines and the perception of scowling.

“How do you determine if I need a browlift or just upper eyelid blepharoplasty (eyelid lift)” Depending on the position of the brow, a patient may need only a browlift, only upper eyelid lift or a combination of both these procedures.

Frequently patients ask us to explain the difference between an endoscopic browlift and a traditional forehead lift. Along with the advantage of smaller incisions, browlifts performed endoscopically have less chance of infection, fewer sensation changes (less numbness and itching), less wound care and fewer side effects following surgery. Also, with endoscopic browlifts there is no compromise to the hair. Not all surgeons are experienced in endoscopic browlifts. When evaluating a surgeon, it’s important to ask not just how many browlifts he or she has done – but, how many endoscopic browlifts have they performed.

A good surgeon, knows that his responsibility is to evaluate not only the areas of concern but also the motivation behind the requests. It goes without saying, a browlift won’t save a failing marriage. Similarly some patients not ready for facial plastic surgery are better served with conservative measures, such as Botox for fine lines and wrinkles or Collagen for crows feet. Patients who educate themselves about facial rejuvenation know when and if the time is right to proceed.

When discussing rejuvenation procedures the best place to start is by looking at before and after photographs to see just what can be accomplished. As you will see in the photos, patients frequently ask to combine a browlift with a facelift or midface lift to elevate “laugh lines” from their downward position and achieve a smoother contour of the jowl area. This reduces jowling in the chin and neck area. One benefit of a simultaneous face lift is the ability to perform liposuction to obtain fat for patients who desire fat injections. The most common request combines blepharoplasty (eyelid lift) for improvements in bags under the eye lids with browlift. Chin implants, cheek implants, rhinoplasty (nasal surgery), otoplasty (ear surgery) and lip surgery can also be performed with a browlift.

Many patients seek information about improving superficial skin wrinkles. Although some improvement in facial wrinkles can be obtained from a browlift, it will not address all the superficial lines that come from premature aging, overexposure to weather and genetics. Browlifts address drooping brows; chemical peel, laser surgery and skin resurfacing address textural wrinkles and imperfections.

At your initial consultation, your surgeon will evaluate the bony and soft tissue architecture as well as the form and function of the head and neck. An overall assessment of the face provides the basis for what one may expect from a browlift. Skin type, ethnic background and age, along with the degree of deformity and function are important factors influencing the outcome of an operation.

As with all facial plastic surgery, a thorough health assessment and realistic expectations are prerequisites. Your understanding of procedures and preoperative and postoperative routines is essential to a successful final result.

BEFORE BROWLIFT SURGERY

At your preoperative appointment our nurse will provide all the instructions for you to follow before and after surgery. On the business day prior to the procedure we ask you to call to confirm your arrival time for surgery. Upon arrival for your surgery, you will talk with a nurse (who will start an IV), discuss local anesthesia with IV sedation (you are asleep for the surgery) and meet with your doctor before going to the operating room. A browlift takes about two hours depending on the underlying structure and amount of excess tissue prior to surgery. If you are having a combination of procedures your surgery time will take longer. Recovery time from the anesthetic takes about an hour and most patients are discharged about four to five hours from the time of admission.

PREOPERATIVE BROWLIFT INSTRUCTIONS

1. Please avoid any aspirin, aspirin-containing products, or ibuprofen for one week prior to and two weeks following your surgery. See our “Medication List” for products to avoid prior to surgery. If you are on any medications that affects bleeding (such as coumadin or warfarin) please notify the office immediately.
2. Please refrain from tobacco products and alcohol for one week prior and three weeks following surgery. Along with delayed wound healing, persistent skin redness and other complications may persist when tobacco and alcohol are not discontinued.
3. Please notify us of all routine medications and significant health history. We ask that you remain on your daily medications unless instructed otherwise. At the preoperative appointment, our nurse will tell you which daily medications to take with just a sip of water on the morning of surgery.
4. At your preoperative appointment you will be given prescriptions for use following surgery including an oral antibiotic, antibiotic eye ointment (if you also have eyelid surgery) and pain medications. Please obtain these prescription medications before your surgery so you will have them ready for use when you return home after surgery.
5. We will ask you to take Vitamin C (ascorbic acid), which helps promote healing, before and after surgery.
6. You may not eat or drink after midnight the evening before the procedure unless instructed otherwise. You may brush your teeth. Your procedure will be cancelled if you do not follow these instructions.
7. Remove all make-up and nail polish before arriving for your procedure.

AFTER BROWLIFT SURGERY

When you wake up from surgery you will notice a soft, bulky head wrap dressing. Attached to your head dressing is a “ball” or drain(s). The drain(s) facilitates removal of excess tissue fluid and helps to prevent infection. Following your browlift, the nurses will ask assist you to meet the discharge criteria: to drink liquids, walk with a steady gait, void, manage your discomfort, and monitor and empty the drain(s). The nurses will review all instructions you will need for care following your browlift. You will be asked to come to our office (not the Surgery Center) the following day after surgery for a dressing change and drain removal. Although most patients describe drain removal as discomfort rather than pain, you are encouraged to take your pain medication about an hour prior to drain removal. You will be asked to return in five to seven days for suture removal.

POSTOPERATIVE BROWLIFT INSTRUCTIONS

Wound care

• Keep dressing dry and intact the evening after surgery. Notify your doctor if the dressings become loose or fall off. Monitoring the amount in the drains is very easy. Our nurses will teach you how to manage the drains.
• Following dressing and drain removal the morning after surgery, you will notice little clips in your hair. We will again instruct you on wound care. Cleaning the suture with a Q-tip dipped in hydrogen peroxide and then applying the antibiotic ointment twice a day is an essential part of the healing process. Keep elastic wrap in place at all times for a few days following surgery, then we will ask you to wear it at bedtime only for about a week.
• You will be asked to return to the office about seven days after surgery for removal of clips. Because most patients tell us their forehead is temporarily numb following browlift, it is uncommon for patients to complain of significant pain with clip removal.

Medications

• Most patients complain of discomfort more than pain. Use pain medication as directed/as needed. Do not drive or drink alcohol while taking pain medication. Taking pain medication with food helps minimize nausea sometimes associated with pain medications.
• Start your antibiotic (Keflex/cephalexin) when you get home and one at bedtime. It is not uncommon to have a low-grade fever for 24 hours following surgery.
• Start swelling medication when you arrive home and at bedtime. Then follow package directions. Take with food.
• Vitamin C (ascorbic acid) helps promote healing. Take 1000 mg three times a day for two weeks following surgery.

Diet

Advance diet from liquids to soft food to your regular diet as tolerated.

Activity

Rest for entire day after surgery. Sleep with head of the bed elevated or use two to three pillows for one week after surgery. Absolutely no bending, lifting or straining. If you have little children, bend at the knees or sit on the floor and let them climb on to your lap. No driving for one week following surgery. Two weeks off work is recommended.

After 24 hours, keep incisions dry except for cleaning and ointment. Bathing is ok as long as you don’t get your incisions/hair wet. You are encouraged to shower and wash your hair twice: once on the evening before clip removal and once on the morning of clip removal (usually postop day seven). Bruising can be camouflaged at one week postoperatively with make-up. Always protect your face from the sun. At this point, a hat and sunglasses are a good idea. Following surgery, our staff will tell you when it is ok to apply sunscreen, cosmetics or facial creams. Avoid unprotected prolonged sun exposure for three months following browlift to prevent pigmentation of incision lines.

Appointments

Your head dressing and drains will be removed the morning after surgery. Clips will be removed seven days following your surgery. You will need transportation to and from these appointments. For the first ten days following surgery, please use our private side entrance (driveway entrance).

Please Remember!

Swelling, bruising and disrupted sleep are very normal postoperative symptoms and will decrease as the healing process occurs. Assistance with daily activities the first two to three days after surgery is strongly recommended.

Final Result

Following browlift, it takes time for the swelling to subside and for the skin to heal. Most patients return to work two weeks following surgery, however three weeks is ideal, depending on the degree of privacy one is trying to maintain. At three weeks postoperatively, swelling and bruising may be apparent to you but not to many of your coworkers and closest friends.

Final results following browlift are not apparent for one full year following surgery. After three months, the changes are ever so subtle, although still important. Being perfectionists about our work, you may tell us you are pleased long before the one year anniversary. However, we request that you follow-up with us at that time for postoperative photographs and so that we can enjoy your final result.