Browlift Procedure
The following information has been prepared to enable you to understand what a browlift is, what it can and cannot do, what the risks are, and in general, what your experience will be after surgery. Do read the information carefully, and if there is anything you do not understand please ask questions.
GENERAL INFORMATION
The browlift is a surgical procedure whose purpose is to improve your appearance. The improvement is achieved by tightening of the brow skin and elevating the brow. The degree of improvement varies from individual to individual, and is influenced by the physical traits of the skin, the structure of the brow, and the procedure performed. Photographs are as important to the plastic surgeon as X-rays are to the physicians in other medical specialties. These photographs are part of your confidential medical record.
NEW ADVANCES
Previously, there was only one browlift- the coronal browlift with a long incision at the top of the head, through which the muscles of the forehead are modified to reflect less age and the brows, usually central and lateral, are elevated.
Now, there are many options. These newer options reflect new knowledge of the importance of the hairline and preserving its natural contours, and the preservation of the hairline, particularly the temple hair and sideburn in women.
We now have minimally invasive browlifts, performed through very small incisions next to the brow itself. This browlift aims at reducing the angry or overly concerned appearance of the central brow, particularly the "frown lines".
While many patients are very happy with Botox injections (Botulinum toxin A) every 3 to 4 months, others desire a more permanent solution, and a browlift is an option. Also, Botox injections cannot elevate tissues the way brow lifts do; they just relieve the wrinkles in the skin caused by the muscles below.
Endoscopic browlifts are available. Surgery is performed through endoscopes which enter above the hairline and modify the frowning muscles and elevate the lateral brow. The brow is fixed in an up position with screws. This approach avoids the long incision at the top of the head, but its results are generally less effective than other methods, and may be more prone to relapse.
For selected patients, especially patients whose hairline is already high due to previous plastic surgery or due to genetics, hairline browlifts can restore a lost hairline while elevating brow tissues to a more youthful level.
THE ANESTHESIA
The brow lift is usually performed under a "light" general anesthetic (patient is asleep) in our outpatient surgical center. Occasionally some patients prefer local anesthesia with intravenous sedation. This anesthetic involves the combined administration of intravenous sedative drugs and the injection of a local anesthetic into the tissues of the face while the patient is asleep. In any event, the patient's safety and comfort remain uppermost in our concerns. All of the required monitoring, anesthetic delivery and emergency equipment are present at all times. The anesthetic is administered by a board certified anesthesiologist doctor who remains in attendance throughout the operation. The appropriate choice of anesthetic will be explained and discussed fully by our anesthesiologist at the time of your pre-operative appointment.
PREOPERATIVE PREPARATIONS
You must be in good health to undergo any elective cosmetic surgery. A physical examination and routine lab work will need to be performed by your own primary physician. If you do not have a primary doctor, we can refer you to local doctors in our area. We do not provide these services. It will be required that all this pre-op paperwork be in our office 1-2 weeks prior to surgery.
It is very important that our office is aware of any medical conditions and all medications you are taking.
It is imperative that you not smoke 2 weeks prior to surgery, and 2 weeks after surgery. This would impede your healing greatly. Talk to us about options.
It is a required that someone drive you home upon your discharge. Also arrange for transportation to and from our office for your post-operative appointments until your doctor gives you permission to drive. DO NOT take aspirin or aspirin-containing products for 2 weeks prior to surgery and for 2 weeks after surgery.
An adequate diet with vitamin supplements, especially Vitamin C, is recommended. You should be in the best nutritional state possible prior to surgery.
If you will be preparing your own meals at home after surgery, have on hand easy to prepare foods
THE SURGICAL PROCEDURE
The length of the operating time varies between one and two hours depending on how much work is done in the various areas of the brow. All procedures performed in this practice are designed with paramount importance placed on the hairline and its preservation.
RISKS AND COMPLICATIONS
In any surgical procedure, there is risk. Certainly the administration of any medication of any sort can have an unpredictable and in extreme cases fatal outcome. Every precaution is taken to prevent possible drug sensitivity, and if it should occur, to treat it properly and avoid any dire consequences.
The risks of brow lift surgery specifically are limited and usually quite rare as well. The most common complication (which is still exceedingly rare) is a collection of blood or blood clot under the skin called a hematoma. If the hematoma is large enough, it will need to be removed by suction aspiration or by opening a small portion of the incision. This will not affect the final result.
In very rare cases there is some breakdown of the skin where it has been undermined, usually in the area immediately in front of the ear. This will heal with a scar which may be permanent but usually is not significant, and can be improved if needed. Patients should absolutely refrain from any smoking around the period of surgery.
Hair loss may occur to a very slight degree around the scars. In rare instances, it may be permanent. Keloid scar formation is very rare in the face but occasionally may occur at the incisions. This is usually of a minimal degree and can be treated appropriately with excellent results. Nerve damage can occur to one of the small branches of the facial or sensory nerves causing weakness of an area of facial musculature or loss in sensation, which may be permanent, but is very rare.
WHAT TO EXPECT AFTER SURGERY
THE RECOVERY:
There is some degree of swelling and possibly bruising in most patients but usually very little in the way of pain or discomfort. Patients who undergo a coronal browlift usually experience some discomfort, itching and tightness in the area above the hairline. It is also not unusual for a patient to experience a day or two of "blues" one to three weeks after surgery. After the initial excitement of the operation has worn off, but before you look as good as you would like to, this mild depression might be experienced. It is not unusual and no cause for alarm and should pass quickly.
There is always some numbness at the site of the incisions. This is normal, and although feeling returns gradually, some numbness may persist for several months. The use of heat (compresses, hair dryers etc.) must be carefully controlled lest the skin be burnt inadvertently.
SWELLING:
Swelling is mostly resolved in two to three weeks, but some swelling will persist to a slight degree for several months. To a large extent, this will be noticed only by you.
BRUISING:
Bruising is usually localized to the area immediately beneath the eyes and the area on either side of the neck. It is usually gone within one week but on occasion may persist longer.
POST OPERATIVE CARE:
It is important to sleep on your back, with your head elevated. This will also reduce some swelling. Using pillows under your arms and knees will keep you from turning to your side.
AS WITH ANY FACIAL SURGERY, AVOID BENDING FORWARD, AS THIS CREATES STRAIN ON ALL INCISIONS THAT ARE HEALING.
The day after surgery the bandages are changed and all the wounds are checked. There will be clips at the hairline that will remain in place for 5-7 days after surgery. A new dressing will be applied which is lighter and smaller than the previous one.
You may shampoo your hair three to four days after surgery.Hair treatments or coloring should not be done for at least three weeks after your surgery. Driving is permitted after one week as is sexual activity (within reasonable limits).
Depending on the degree of the surgery, most patients are quite "presentable" within one to two weeks.
RESUMPTION OF PHYSICAL ACTIVITIES - GENERAL RULES OF THUMB: TWO, FOUR, SIX RULE
First Week:
TAKE IT EASY!!! PATIENTS WHO ARE TOO VIGOROUS FREQUENTLY DEVELOP COMPLICATIONS!
At two weeks:
Take long walks on a flat surface. No other kind of workouts. Any activity that would raise your blood pressure would compromise the healing incisions and newly developing blood supply.
At four weeks:
Light exercise such as aerobics, but no weight training. Start light. For example, if you normally do 30 minutes on a treadmill, begin with 15 minutes, then increase as your body gets used to things. Use of vitamin C and E concentrate and scar-fade gel should begin as soon as the incisions are completely healed, usually 3-4 weeks.
At six weeks:
Resume all previous activities with clearance from Dr. Moelleken. Avoid sun exposure to incision site for months following surgery, as this may result in a hyperpigmented scar.
