100 plastic surgery

How is a brow lift procedure performed?

• Open brow lift. Your surgeon makes a long incision across the forehead, either around the hairline or in one of the creases of the forehead, and lifts the skin away from the underlying tissues. The surgeon then loosens muscles and removes fat. He or she removes any excess skin, pulls the remaining skin down, and stitches the brow into its new position. Other names sometimes used to describe open brow lift include classic, coronal or trichophytic brow lift.

• Endoscopic brow lift. Your surgeon will insert an endoscope (a long, thin tube with a light at the end attached to a video camera) through several tiny incisions in the scalp. This allows your surgeon to see and work on the various internal structures of the forehead. The endoscopic technique requires very minimal incisions, but it may not be equally beneficial for all patients.

• Limited incision technique. This hybrid technique of both procedures is non-endoscopic with limited incisions. It uses a small portion of the ends of the coronal technique incision to elevate the outside part of the eyebrows under direct vision without an endoscope. The resulting scars are hidden in the temporal hairline, even in balding men who have little temporal hair remaining. While this procedure does not address the center area of the brow, it can reduce wrinkles at the corners of the eyes, commonly referred to as 'crow's feet.' Since many forehead-lift procedures are performed with an upper blepharoplasty, the upper eyelid incisions are used to complete the forehead-lift procedure by treating the 'frown' lines between the eyebrows and raising the inside part of the eyebrows.

What are my options?

• If you have mild to moderate brow droop and horizontal wrinkles, an endoscopic lift may be a good choice.
• If you have advanced brow droop with deep wrinkles, a coronal forehead lift may be most appropriate.
• If you have a high forehead, to avoid raising your hairline further, you may undergo a subcutaneous lift. In this procedure, your incision is near the hairline, leaving visible scars that can be hidden with hair.

What will my brow lift incisions and scars be like?

A

B

1. The endoscopic brow lift uses several small incisions within the hairline. Incisions and placement vary.
2. Once incisions are made, the eyebrows are raised and repositioned along with the underlying muscle (as needed).

Select a surgeon you can trust

• Education, training, and certification
• Experience with brow lifts
• Your comfort level with him or her

Your initial consultation appointment

• Do you have any medical conditions or drug allergies? Are you being treated for any medical conditions?
• Have you had any previous surgeries?
• What are your current medications and vitamin and herbal supplements?
• What is your current use of alcohol, tobacco, and recreational drugs?
• What is your history with any noninvasive cosmetic procedures?
• What outcome do you expect from the surgery? What is your chief motivation in undergoing brow-lift surgery?

• Ask you to look in a mirror and point out exactly what you would like to see improved.
• Take photos for your medical record, measure your face, and use computer imaging to show you the improvements you can expect
• Evaluate your health status, including pre-existing health conditions or risk factors
• Evaluate the elasticity of your skin
• Discuss your options and recommend a course of treatment
• Discuss likely outcomes, including risks or potential complications
• Discuss the type of anesthesia that will be used

Your treatment plan

• An approach to your surgery, including the type of procedure or combination of procedures
• The outcomes that you can anticipate
• Your financial investment for the procedures
• Associated risks and complications
• Options for anesthesia and surgery location
• What is needed to prepare for the surgery
• What you can expect to experience after surgery
• Share before-and-after photos of cases similar to yours and answer any questions.

Questions to ask your aesthetic plastic surgeon

• Am I a good candidate for a brow lift?
• Are the results I am seeking reasonable and realistic?
• Do you have before-and-after photos I can look at for this procedure?
• Will my scars be visible?
• What kind of anesthesia do you recommend for me?
• What will be the costs associated with my brow lift?
• What will you expect of me to get the best results?
• What kind of recovery period can I expect, and when can I resume normal activities?
• What are the risks and complications associated with my procedure?
• How are complications handled?
• What are my options if the cosmetic outcome of my brow lift does not meet the goals we agreed on?

How do I prepare for a brow lift procedure?

• If you smoke, your surgeon will ask you to stop at least six weeks before your surgery. Smoking greatly increases the risk of complications and slows the healing process.
• You may have to limit alcohol consumption and avoid certain medications.
• If you regularly take aspirin or another anti-inflammatory drug, your surgeon will ask you to stop taking these for a period before surgery. These drugs can cause increased bleeding.
• Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery.
• If your hair is short, you may want to grow it out to cover any scars.
• Make arrangements to be driven to and from surgery on the day of your procedure.
• You should have someone to take care of you on your first night home and, if possible, the first two days following surgery.
• Fill all prescriptions before surgery.
• Set up your recovery area ahead of time. You should have easy access to fluids, prepared meals, pillows to elevate your head, and reading materials and entertainment.
• Prepare ice packs. Frozen vegetables work well to reduce post-operative swelling.

• Medications will be administered for your comfort during the surgical procedure.
• Local anesthesia combined with sedation is commonly used during brow-lift surgery, though general anesthesia can be used instead.
• For your safety during the surgery, various monitors will check your heart, blood pressure, pulse, and the amount of oxygen circulating in your blood.
• An anesthesiologist or nurse anesthetist will be present to administer sedatives (or general anesthetic) and assist in monitoring.
• Your plastic surgeon will follow the surgical plan discussed with you before your operation. Once surgery has begun, the surgeon may decide to combine various techniques or change a technique to ensure the best result. It is important that you feel comfortable and trust your doctor to make these decisions.
• Sections of hair will be held away from the surgery area.
• After removing excess tissue, skin, and muscle, your surgeon will close the incision with stitches or staples. Your hair and face will be washed so the scalp skin does not get irritated.
• The treated area will be wrapped with a sterile padding and an elastic bandage to prevent bleeding and swelling (edema). You will have sutures and a dressing on your forehead for the first few days after surgery. After surgery, you will be taken into a recovery area where you will continue to be closely monitored.

• Incision care
• Normal symptoms you will experience
• Any potential signs of complications

• Your surgeon may suggest icing or cold packs around the eyes for forty-eight hours to reduce the swelling.
• It is best to sleep with your back and head elevated for approximately five to seven days.
• Your surgeon will likely ask you to come back to his office a day or two after surgery so he or she can evaluate your healing.
• Pain is typically not a significant problem in brow lifts. There is, however, some discomfort and tightness from ear to ear across the top of the head and brow. Most patients describe their forehead as feeling tight and somewhat numb the night of surgery. You will be provided with pain medications should you need them.
• Drains are usually not needed in the brow area when doing a brow lift.
• Temporary bruising, swelling, and numbness are common the first night after surgery. Maximum swelling occurs forty-eight to seventy-two hours post-surgery and begins to subside on the fourth or fifth post-operative day.
• You may need to go to the bathroom frequently because of the intravenous fluids you were given during your surgery. Drink plenty of fluids to keep up with the fluid loss. As your body begins to balance itself, it will rid itself of this extra 'water weight' and return to normal.
• Bruising from a brow lift appears less in the brow than in neighboring areas. As a result, any bleeding usually collects below the eyelids and bruises the lower lids, even if the lower lids are not operated on. Bruising usually peaks on the third to fifth day and resolves over two to three weeks.
• Showering and bathing are permitted the next day after surgery. Use hair conditioner to help wash and clean hair that became matted or knotted during surgery. Be cautious when applying hot water, hair dryers, and combs; your scalp will be numb, so they may damage your skin and/or hair.

• Your sutures or staples will be removed approximately one week after surgery.
• During the first week of recovery, you should move and be mildly active, including going for walks to aid circulation in your lower extremities. However, do not attempt heavy lifting or strenuous activity.
• You can resume driving when you are able to drive as well as you did before surgery. You need to be able to brake, respond, and turn quickly. When these conditions are met, you may resume driving, typically in the second or third week after surgery.
• You may be able to return to work within a week and to full activity within a few weeks, but you must avoid heavy lifting or straining during this time.
• Sensation in your scalp may be temporarily reduced. The feeling will begin to return over the first few weeks after surgery and your scalp will begin to feel 'itchy' as the nerves reawaken. Total numbness behind the incision in an open brow lift will usually persist for nine to twelve months post-surgery, sometimes longer in rare instances.

• You should have returned to your normal rhythm at work by this time, depending on the amount of physical exertion required to perform your duties.
• Begin exercise and workout routines. Avoid any activity that causes discomfort and/or pain until you are further along in your recovery process. When you return to the activity, start at half speed and increase to your normal routine as long as you do not feel any pain during and/or the day after your workout.

• Adverse reaction to anesthesia
• Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
• Infection and bleeding
• Changes in sensation
• Scarring
• Allergic reactions
• Damage to underlying structures
• Unsatisfactory results that may necessitate additional procedures.

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