Facial Rejuvenation Procedure
brow lift / forehead lift
ABOUT THE PROCEDURE:
Minimize forehead creases, drooping eyebrows, hooding
over eyes, furrowed forehead, & frown lines by lifting excess tissue & redraping
skin. Usually done with Endoscope.
LENGTH:
2 hours.
ANESTHESIA:
General / Outpatient Surgery.
SIDE EFFECTS:
Temporary swelling, numbness, headaches, bruising. Possible
itching & hair loss at incision sites for several months. Change
in hairline (RARE) unless planned.
RISK:
Injury to facial nerve, causing loss of motion, muscle weakness,
or asymmetrical look. Infection. Broad or excessive scaring.
RECOVERY:
Back to work 7 to 10 days.
EXERCISE:
1/3 Intensity at 3 weeks, 2/3 Intensity at 6 weeks, Full Intensity
at 8 weeks.
FADING & SCAR IMPROVEMENT:
6 to 12 months.
HAIR CARE:
Color or highlights at 4 weeks.
BRUISING:
2 to 4 weeks.
SWELLING:
Moderate/Significant 4 weeks, Subtle/Mild 2 to 3 months, all
of which are dependent upon extent of procedure(s).
RECOVERY:
All facial surgery: Feel OK at 2 weeks. Look better than Pre-op
at 4 weeks, subtle/soft improvement for 6 months.
DURATION of RESULTS:
Usually 5 to 10 years.
OFFICE VISITS:
1st Visit 1 day / 2nd Visit 5 days. Anticipated office visits 7 to 10 the first 3 months, 6 months then once, yearly.
GARMENT WORN:
N/A
PAIN MEDS:
Ibuprofen or Narcotics as needed.
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More Information About the Brow Lift
- Also known as Forehead Lift or Upper Face Lift
The aging process which produces wrinkling and sagging of facial soft tissue occurs in all areas of the face. Often it is more apparent in the lower two-thirds of the face (from the eyes down) than in the upper one-third of the face, but usually occurs simultaneously in both areas. FACE LIFT procedures usually refer to correction of sagging skin and wrinkling in the LOWER TWO-THIRDS of the face. BROW LIFT procedures refer to operations directed at improving the UPPER ONE-THIRD of the face. It is important to recognize aging abnormalities in the upper one-third of the face, since after correction of the lower two-thirds of the face, an uncorrected forehead/brow area may be more apparent.
Aging abnormalities in the upper one-third of the face include:
1) TRANSVERSE FOREHEAD WRINKLES,
2) GLABELLAR FROWN LINES (vertical lines between the eyebrows),
3) HORIZONTAL WRINKLES AT THE ROOT OF THE NOSE (in the area between the eyes), and
4) DROOPING OR SAGGING OF THE EYEBROWS, upper eyelids, and upper nasal tissues.
Several factors affect the aging process in the upper face. Inherited tendencies and the degree that you animate your face with facial expressions contribute to formation of wrinkles and frown lines. Deeper skin wrinkles are produced when the muscles of facial expression that lie underneath the skin contract. An example is the formation of horizontal lines across the forehead when you raise your eyebrows in a surprised expression. Another example is the vertical lines which form between the eyebrows when you frown. The action of these muscles is important to facial expression, but overaction and its effect over long periods of time accelerate the aged appearance. In addition to the information contained here, during your consultation and examination, we will review specific factors which pertain to your individual case. (As you review this information, please write questions in the margins that we can address during your consultation.)
All facial tissues normally descend or sag with aging. The forehead/brow area is no exception, though it may sag slightly less than the lower two-thirds of the face. AS THE TISSUES OF THE FOREHEAD DESCEND, THE POSITION OF THE EYEBROWS CHANGE SIGNIFICANTLY. Eyebrow position and shape dramatically affect the appearance of the face. Sagging of the outer portion of the eyebrows denotes sadness, sagging of the inner portion denotes anger or scowl, and sagging of both the inner and outer portion of the brows with the loss of the normal brow arch produces an appearance of tiredness. Properly arched and positioned eyebrows make the eyes appear larger, fresher, and brighter.
THE POSITION OF THE BROWS AND FOREHEAD ALSO AFFECT THE APPEARANCE OF THE UPPER EYELIDS. When the forehead and brow is sagging, the upper eyelid also sags. Bags or excess sagging of skin in the upper eyelids may be due to DESCENT OF THE FOREHEAD AND BROWS as well as EXCESS SKIN AND FAT IN THE UPPER EYELIDS THEMSELVES. It is important to recognize the contribution of brow sagging to upper eyelid deformities, because removal of skin and fat from the upper eyelids alone will not correct abnormalities of the brow and forehead. If skin is removed from the upper eyelids without planning for correction of the brow position, the amount of brow lifting that can be done in the future is limited. Usually, POSITION OF THE FOREHEAD AND EYEBROWS SHOULD BE CORRECTED EITHER BEFORE OR AT THE TIME OF UPPER EYELID CORRECTION in order to avoid removal of too much skin in the upper eyelids which could effect eyelid closure.
The surgical procedure designed to correct the forehead and eyebrow abnormalities is termed BROW LIFT. This procedure has two distinct objectives 1) PROVIDES UPWARD LIFT OF THE FOREHEAD AND BROW TISSUES TO DECREASE FOREHEAD WRINKLES, and 2) REPOSITIONS THE EYEBROWS IN AN UPWARD DIRECTION to correct their sagging. Since forehead wrinkles are produced by the action of muscles lying underneath the skin, continued excessive muscle action following the procedure would, over a period of years, produce recurrence of the wrinkles which were corrected. To minimize this recurrence, the muscles in the central portion of the forehead and brow areas, where wrinkling is most prominent, are usually weakened or partially divided at the time of the operation. Muscle action over the sides of the brow and forehead area is left intact to maintain adequate animation for normal expression.
When stretch is applied to any tissues, the tissue exerts some counter pull in the opposite direction. The forehead is lifted upward and over a period of approximately six months it will tend to stretch back slightly. For this reason, at the time of the operation, the forehead and eyebrows are lifted slightly above their desired final position, allowing for a slight descent over the ensuing weeks and months. Since there is a limit both to the amount of stretch which can be placed as well as the optimal position of the eyebrows, wrinkles are never totally erased from the forehead, but are improved. Lifting of the forehead tissues can raise the hairline slightly. In most instances, the amount of elevation is minor and does not require hair styling change. If you have an extremely high hairline, the location of the incision can be modified to minimize hairline elevation.
I prefer to use limited incisions for brow-lifting. This procedure is called an ENDOSCOPICALLY ASSISTED BROWLIFT and uses special instrumentation and video monitors to visualize the surgical site and perform the procedure. Smaller incisions allow for faster healing, less conspicuous scars, improved long-term scalp sensation and reduces operative time.
As with any facial rejuvenation procedure, a surgical technique must be modified, customized and individualized depending upon patient anatomy and desires. The endoscopic technique allows for this. Modifications of this technique can include approaching the muscles between the eyebrows through an upper eyelid incision when appropriate. The direction of upper or lateral pull can be changed as needed to obtain the desired result.
From an aesthetic perspective it is very important to emphasize elevation of the lateral brow in females, but leave the area between the eyebrows softened, not over pulled. In males, the goal should be a flatter and softer elevation of the brow. Again, upper eyelid excess must be addressed appropriately to obtain a harmonious relationship in the periorbital region (around the eyes).
Facial rejuvenation surgery may be performed as an isolated procedure or more frequently done in conjunction with other cosmetic procedures of the face. They may be performed under local or general anesthesia depending upon the extent of the procedure being performed, medical indications or patient preference. In general, I do believe, along with our board certified anesthesia colleagues, that for longer and more complex surgical procedures general anesthesia is a better and safer choice than local anesthesia alone or local anesthesia under sedation.
The purpose of all types of cosmetic surgery is to improve your appearance as much as possible. This change will hopefully improve your quality of life by improving your self image in a very positive way. By addressing and improving those specific areas which detract from your appearance, leaving the positive aspects of your appearance undisturbed, this type of surgery results in an overall improvement in your appearance. Cosmetic surgical procedures are not magic. They are detailed procedures designed to improve specific aspects of your appearance. They can do no more than that. Whether you are happy with the results of cosmetic surgery will depend largely on how well you communicate to us which specific aspects of your appearance you are unhappy with and how well we communicate to you what a surgical procedure can and cannot do toward alleviating the problem. Plastic surgery does not perform transforming miracles. A combination of art and science, plastic surgery is not an exact science. Some of the factors involved in producing the result (such as your healing characteristics) are not totally within your or our control, and therefore, it is impossible to warrant or guarantee the results of your surgery. How predictable the result of your surgery will be depends on
a number of factors such as the condition of your skin, the presence or absence of facial fat beneath the skin, the age characteristics of the skin, numbers and types of wrinkles present, and the nature of underlying bony structure of the face, as well as hereditary and hormonal influences.
It is not possible by cosmetic surgical procedures to make someone who is 50 years old appear 30 years old or younger. Although this may seem obvious, through misconception or misinformation, these ideas reach the public. All surgical procedures which involve an incision in any area must leave a scar. While these scars are usually inconspicuous and easily camouflaged by makeup or hairstyle, they are nevertheless permanent and cannot be erased.
After talking with you and examining you, I will make every effort to clearly and precisely give an opinion about whether a specific surgical procedure can significantly improve your areas of concern with a high degree of reliability and a minimal level of risk. All cosmetic surgical procedures involve some trade-offs. I will try to outline these clearly for you and answer any questions you might have. The final decision regarding having the surgery is yours, and I encourage you to consider it carefully and deliberately.
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AT YOUR INITIAL CONSULTATION:
When I visit with you in the office, I will review your past medical history, as well as your desires regarding facial rejuvenation. Age is not a limiting factor in determining who can have facial rejuvenation, as long as your general health is good. We will review extensively the information contained here, as well as more specific information with respect to your specific needs. After examining your brows and eyes, I can much more precisely define recommendations for you.
In this consultation, I would expect you to be frank in discussing your expectations with me. Do not hesitate to ask any questions that you may have. I will be equally frank with you, explaining the factors that could influence the procedure and the results.
I cannot make the decision for you regarding whether to undergo surgery or not. I can only advise you regarding the surgical options and anticipated outcomes I would expect for you based upon your individual anatomy, desires, and realistic expectations. I will define goals in a surgical plan at this initial consultation. Follow up appointments will include time to ask further questions or review the procedure so that you are comfortable with its nature and implications. I will educate you and define the operative scenarios and choices available to you, but you must make the final decision regarding the surgical procedure.
When a decision is made to proceed with surgery, preoperative photographs will be taken. These photographs are essential to the planning, execution, and follow-up of your procedure. They are taken with you in the standing position (the position in which you are most often seen). You are lying down during the procedure and I refer to these photographs frequently as your tissues appear very differently than when you are standing.
Surgical fees for the procedure will be discussed with you. They depend upon the nature and the extent of the procedure being performed. All fees for cosmetic surgeries are payable in advance and include the cost of surgery as well as all postoperative follow up care. Additional fees are required for the surgical facility and anesthesia care, and will be collected on the day of your preoperative visit at the surgery center.
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BEFORE YOUR BROWLIFT:
Our nurse and office manager will make all arrangements regarding scheduling of your surgery and will give you specific instructions as well as reconfirm these with you by telephone and/or letter. Since both of our schedules must be coordinated with the surgical facility and anesthesia schedules, please allow our personnel a reasonable amount of time to make these arrangements. They will make every attempt to accommodate your requests.
Good general health is mandatory for a problem free and predictable recovery from any surgical procedure. Wellness and good general health result from proper diet, regular exercise and appropriately timed medical evaluations focused on preventative medicine. Good nutrition, vitamin and herbal supplements, as well as adherence to holistic health principles are important concepts in maintaining wellness. Certain supplements, although generally beneficial, may have adverse effects during surgery. Please advise us about all your medications and supplements, so we may advise you regarding their safety in regard to your surgical procedure.
We believe that good nutrition is an important component to excellent surgical outcomes. Multiple studies show that most Americans aren’t getting the recommended daily intake of necessary vitamins and minerals, much less the optimal amount. These suboptimal levels of nutrients have been linked with major diseases from heart disease to cancer.
We use a three phase healing program with nutritional supplements to help you recover more quickly and with less downtime. We have you start this a week or so ahead of time to ensure that you are boosting your body’s immune system and removing anything that could interfere with anesthesia or increasing bleeding. Immediately following surgery we give you nutrients that help reduce pain and inflammation and detoxify the anesthesia and other medications. The third phase has additional healing nutrients to support your recovery.
Routine laboratory tests including blood counts and blood chemistries, a pregnancy test when applicable, and an electrocardiogram if you are over 50 years old, will be performed prior to surgery. These tests are performed routinely to screen for any abnormalities, which might complicate your anesthesia or surgery.
Do not take any aspirin or any drug containing aspirin for at least two weeks prior to your surgery. Aspirin may retard platelet function, a blood component that is important to normal blood clotting mechanisms. There are many drugs which contain aspirin. Before taking any drug, check the label carefully to assure that it contains no aspirin.
Do not eat or drink anything 8 hours prior to surgery. Safety in the administration of anesthesia or sedation requires that your stomach be absolutely empty for this interval of time before surgery.
Shower or bathe normally the evening prior to surgery.
You should wear loose fitting, comfortable clothing the day of surgery. A loose fitting shirt with buttons in front is preferable to any type of clothing which must be put on over the head. Please be sure that you have all of your questions answered prior to going into the surgical facility. I prefer that you make an additional appointment in the office if necessary to answer questions regarding your surgery. On the day of surgery, I will visit with you briefly immediately prior to surgery. Any final questions will be answered at that time.
Arrange for someone to drive you home at the appropriate time following your procedure, and arrange for someone to stay with you the night of surgery.
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THE DAY OF SURGERY:
I usually prescribe sedation or premedication prior to your being brought to the operating room. In order to minimize total necessary doses of drugs, sedation is best administered through an intravenous line rather than given in shot form into your muscle. It is normal to be slightly excited or apprehensive immediately prior to the surgery, and this will be alleviated quickly once your intravenous line is inserted. Our anesthesiologist will speak with you and answer all of your questions regarding your anesthetic.
Prior to moving to the operating room, I will ask you to sit up briefly so that I can mark your surgical sites to use as guidelines during your surgery. Once in the operating room, you will then be positioned comfortably, and will have no recall of further events during your surgery.
The operation is performed using a general anesthetic. In addition, the medications have a profound amnesic effect, and you will have no recall of any events during the procedure. Actual surgical time usually ranges from 45 minutes to an hour and a half depending on the technique chosen.
A brow lift is most commonly performed with several small incisions in the scalp utilizing an endoscope to visualize the surgical site and guide the instruments used to perform the browlift. Through these incisions, forehead tissues are undermined, appropriate muscles are weakened, and the forehead tissues are then stretched upward. Great care is taken to not trim hair so that the hair abuts directly at both sides of the incision, leaving no bare areas. With stretching upward of the forehead tissue, wrinkles are markedly decreased and position and arch of the eyebrows corrected.
At the completion of your operation, you will be transferred to the appropriate recovery area where you will remain until you awaken. I purposely like for you to remain drowsy, since you will be much more comfortable. After an appropriate interval of observation, usually a few hours, you will be allowed to leave with someone to drive you home and stay with you the evening of the surgery.
You will have been given prescriptions for pain medication and antibiotics with instructions for each at your preoperative visit.
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AFTER YOUR BROW LIFT:
Since I want you to remain drowsy and comfortable the evening of your surgery, fill your prescription for pain medication before surgery and take one immediately on arrival at home. Pain medication is best taken with a small amount of food and not on an empty stomach since nausea may occasionally occur. Make yourself comfortable, not necessarily in bed; a couch or comfortable chair is fine. You will continue to be drowsy and will awaken intermittently during the evening. Use the pain medication as directed to remain comfortable. Intermittent cold compresses for the first 48 hours after surgery may help with swelling and discomfort.
Do not try to eat any heavy foods the evening of surgery. Liquids or light foods are preferable. You may resume a normal diet the next morning. Should you experience any nausea the evening of surgery, drink small amounts of liquids only: no food until morning. Anti nausea medications are generally not needed; any nausea experienced from the medications used in surgery will usually be gone the next morning. If you have a history of nausea after anesthesia, please inform your anesthesiologist the morning of surgery and you will be given anti-nausea medications during the procedure that will help minimize this occurrence after surgery.
Swelling and bruising which occurs in the forehead gravitates downward into the upper eyelids and noticeable bruising in this area is normal and will persist 7-14 days. As the bruising resolves, the purplish discoloration changes to yellow and gravitates downward into the lower eyelid and cheek areas.
You may wash your hair the day following surgery, and towel dry it or dry it with a cool blow dryer. Avoid excessive heat in these areas since the tissues around the incision area will remain numb for a period of weeks until sensory nerves regrow, and can be easily burned without your recognition. A small amount of drainage from the incisions normally occurs for 48-72 hours and needs to be cleaned and antibiotic ointment applied.
Areas of the forehead following a brow lift normally have some decreased sensation or numbness for a period of weeks. This numbness resolves as sensory nerves regrow to the lifted skin.
As discussed with you preoperatively, the tension placed on the forehead skin to achieve the desired correction decreases slightly with time. This decrease in tension will relieve the tight feeling that you will have during the first weeks to months in the forehead and will allow the position of the brows to descend slightly to their final corrected position. In order to prevent recurrence of deep wrinkling due to muscle action in the forehead, the forehead depressor muscles have been weakened at the surgical procedure. Combined with the swelling following the operation, movement of the forehead will therefore be significantly decreased for the first few weeks following surgery. Movement resumes as the swelling subsides and tissues become more pliable.
For the first few weeks following surgery, if the brow position appears excessively high to you, you can pluck the upper margins of the brow, allowing margins to fill in or penciling them in to achieve the appearance of lower brows.
If you are given a prescription for antibiotics following surgery, take the prescription until ALL of the antibiotics are completed.
Resume normal tasks of daily living as rapidly as possible. The pain from the procedure decreases to about half of its intensity each 24 hours following surgery. Postoperative discomfort is most marked only during the first 24 hours and regresses rapidly thereafter. Resumption of normal activities, for example, lifting the arms to comb the hair and lifting objects of normal weight, speeds the recovery process and reduces the pain more rapidly. Immobility tends to cause continued discomfort and increased muscle spasms. The only limitation to activity is if you feel significant pain. Discomfort is normal with motion initially, and there is nothing that can be harmed by normal activity. Most patients are back at work in 5-7 days. Call the office for an appointment to be seen as directed following surgery.
You may resume light exercise at 3 weeks following surgery. This includes low impact activities at 1/3 duration of exercise, repetitions, amount of weight, and pulse rate. Your exercise tolerance should gradually increase to 2/3 intensity at 6 weeks, and be at full intensity by 8 weeks. This includes high impact activities such as running, horseback riding, and high impact aerobics.
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LIMITATIONS, RISKS, AND POSSIBLE COMPLICATIONS
OF CORONAL BROWLIFT:
With any surgical procedure, a very small percentage of untoward complications can occur. These complications are rare, and I mention them not to alarm you, but only to inform you.
The two sides of the face are never the same in any individual. I will make every attempt to correct discrepancies and provide as much symmetry as possible during your procedure. Due to healing factors which we cannot control, as well as other variables, there will inevitably be very slight differences between the two sides postoperatively. These differences are very slight and within the range of normal variation in most individuals. Following any surgical procedure to improve the appearance of your face, you will look at your characteristics much more carefully and more likely notice minor asymmetries.
It is possible to have untoward side effects to any drug which is administered, during surgery. Severe side effects are extremely rare, but can be life threatening. It is for this reason that I insist on performing your surgery in an optimal setting where all conceivable equipment and medical backup are available should you have an unexpected reaction. Anesthetic or sedation risks are extremely minimal. Many cases have been vastly over publicized by the media, and most have occurred in settings where less than optimal facilities, equipment and personnel are present.
The first several weeks following surgery, the forehead usually feels rather tight, similar to wearing a hat which fits tightly. When the forehead tissues are lifted, nerves which course upward from the area of the eyebrows into the forehead are stretched. This usually results in some degree of decreased sensation or feeling of tingling or numbness in the forehead areas for a few weeks. These sensations are generally tolerable, and subside over several weeks, sometimes months.
Although bleeding or infection requiring an additional procedure can occur following any type of surgery, these problems are extremely rare with an endoscopic browlift. When making the incisions for this procedure, we are very careful to preserve and protect the hair follicles and minimize the possibility of hair loss following the procedure. Loss of small areas of hair in and around the incision area is rare, but possible. Hair regrowth may take several months. Rogaine® is helpful to stimulate hair growth.
As discussed above, to correct and preserve the correction of deep forehead wrinkling, certain muscles in the forehead are intentionally partially weakened. The extent of weakening and hence of residual expressive motion vary according to the procedure required and this will be discussed with you during your consultation. Excessive weakening of forehead muscle resulting from excessive muscle weakening or nerve injury are possible, but also extremely rare.
All of the above-mentioned limitations, risks, and possible complications of a browlift are unusual, but may occur occasionally despite the most vigorous standards of medical practice. They are described here not to alarm, but to adequately inform you prior to your surgery.
Any change in your appearance affects your perception of self-image, and requires a period of days to weeks to adjust. It is normal to have mild feelings of doubt or low mood during this adjustment period in the first 1-3 weeks following surgery. These feelings are then rapidly replaced by positive feelings as healing progresses and you adjust to your new appearance.
CONCLUSION:
Brow lifting is a very helpful and rewarding procedure in correcting characteristics of aging in the forehead, brow, and periorbital areas. It is a predictable procedure with minimal discomfort and improves the tired, sad, or angry appearance which results from malposition of the eyebrows. The procedure also markedly improves transverse and vertical wrinkling in the forehead areas.
During your office consultation, additional and more detailed information regarding all of the areas mentioned in this information sheet will be provided you as well as an opportunity for you to ask in-depth questions. Please review this sheet carefully, and write down any questions you may have.
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