As we age, the effects of gravity can cause the upper third of the face to descend. The soft tissues of the brow drop onto the upper eyelids giving the eyelids the unwanted appearance of heaviness. Transverse creases across the forehead also develop, as well as deep wrinkles above the nose. Many find these changes give them a tired or even angry appearance, rather then the more relaxed look they may want.
To remedy these issues, multiple options exist. The most traditional involves working on the muscles through an incision across the top of the scalp and removing a strip of scalp to elevate the brows and forehead. An incision placed at the hairline may also be used, avoiding an elevation of the hairline but risking a more visible scar. Still other techniques involve shorter incisions, but offer a more subtle change. The shorter incision techniques do not affect sensation as much as traditional procedures.
Currently, in most instances, surgeons prefer a technique known as endoscopic brow lift. This technique uses a series of smaller incisions, giving access the brows and forehead. A tube with an attached camera attached (an endoscope) is used to perform the procedure, without the need for longer incisions used in other techniques.
Traditional approaches, using longer incisions, produce more visible scarring as well as a degree of sensation loss at the top of the scalp. Because endoscopic techniques use smaller incisions, they tend to be less noticeable scarring and less sensation loss. Though endoscopic techniques offer several benefits many people prefer, the traditional, open approach may still be recommended for individuals addressing more extensive issues.
Your plastic surgeon will typically spend 45 minutes to an hour in consultation with potential patients, obtaining a medical history, conducting an examination discussing a patient’s concerns and goals in detail. The examination includes an assessment of forehead contour, eyelid appearance and bone structure and symmetry issues.
The relationship of the brows, forehead and eyelids with the remainder of the face is also evaluated. He will take this time to discuss my observations and recommendations for potential treatment, keeping in mind that every patient is unique with and individual ideas which aging signs bothersome to them at that point in time. Only certain procedures may be desired.
This procedure should only be performed at a fully-accredited surgical facility, and anesthesia is administered by board certified anesthesiologists. Local anesthetic will be used on forehead and scalp to control post-operative pain. On the day of the areas discussed will be elevated and muscle adjustments made as felt to achieve the desired results. Typically, no dressings are needed after this procedure.
After the procedure, pain is usually controlled through oral pain medicine and a cooling mask. Most patients return home the day of surgery, though it’s recommended a responsible adult stay with them for at least the first night. Driving should be avoided until oral narcotics are no longer required for pain control.
Patients undergoing additional procedures, such eyelid and/or facelift surgery often stay 1 or 2 nights in a post-operative facility for the sake of safety and comfort. Though ambulation is encouraged the night of surgery, strenuous activity should be avoided for at least 2 weeks after the procedure. Many patients report headaches as well as a sensation of tightness, particularly during the first week after surgery.
Though many patients begin to notice an aesthetic improvement after 5 to 7 days, it generally takes at least 2 weeks for much of the swelling and bruising to disappear. Any areas of sensation loss generally improve during the first two years. By two weeks patients generally feel that they appear more rested and that their upper eyelids feel less heavy and appear wider and more attractive.
What Are Some Of The Particular Concerns Of Brow Lift Surgery?
While patients tend to be quite pleased with the results they achieve, this surgery does have some inherent risks that must be considered. It should be noted that some elevation of the hairline will occur, even with endoscopic procedures.
Though this does not tend to be a significant concern for most, the hairline must be evaluated in each patient before the procedure. It should also be understood that some areas of numbness may occur, though with endoscopic procedures these are generally minor and improve with time. There is also a risk of temporary or permanent loss of brow or forehead movement.
Brow position asymmetry can result, and pre-op asymmetry issues cannot be addressed with this procedure. This procedure, though beneficial, is not a permanent solution to brow and forehead issues. Over time, due to the constant pull of gravity, they may again drop resulting in the recurrence of the initial aesthetic issues.
Making the decision
Every surgical procedure has inherent benefits, risks and limitations. Your plastic surgeon will want all potential patients to feel comfortable asking any and every question they may have during consultation and pre-operative visits. A good plastic surgeon will take the time to assist potential patients in determining whether a undergoing a brow lift, or any other cosmetic procedure, is the right choice.