Background On Browlifts
The various components of the face tend to age equally. So, while many individuals see the aging process affecting their eyes, cheeks, jaw line and neck, they are not as aware that the forehead is subject in the long-term to forces of gravity and time as well. With age, the upper third of the face from the tissue just above the upper eyelids to the hairline can begin to descend and wrinkles can develop not only horizontally across the forehead, but also between the eyebrows, giving one a tired or even sometimes angry appearance. The procedure known as a forehead lift, or browlift, removes the wrinkles from the forehead and elevates the eyebrows, creating a fresher more rested appearance. Often when patients feel they have sagging upper eyelids, in fact they have a sagging browline. Typically, if one manually raises the eyebrows it becomes clear what forehead rejuvenation can accomplish.
There are two basic approaches to lifting the forehead and treating the frown lines between the eyebrows. The more traditional approach involves making an incision across the top of the scalp and after working directly on the frown line producing muscles, removing a strip of scalp and re-approximating the edges. This is a time-tested method with a good track record for producing predictable and long-lasting results.
A more recent method is known as an endoforehead lift, and involves an indirect approach of repositioning the scalp in an upward direction after freeing up the forehead from the underlying bone using an illuminated tube with a camera attached to it and using special instrumentation designed to work through several small incisions in the scalp. Under video guidance, the surgeon works on the frown muscles and frees up the attachments of the eyebrows around the eye sockets so they can be shifted upward to a more youthful position. The forehead is anchored permanently to a higher position on the skull.
The advantages of the traditional approach are that a more controlled contouring of the shape of the eyebrow can be obtained. The procedure has been in use for a long time, and the results are long-lived. Complications are few, but include the possibility of a prominent scalp scar, with possible loss of hair along the incision line. Many people develop numbness in a small patch of scalp at the top of their head.
The advantages of the endoforehead lift are that the scars are less lengthy and therefore possibly less noticeable. There is less risk of numbness of the scalp. The recovery may be slightly shorter without the need to heal a long incision line. Though complications are few, they include loss of hair at the small incision sites, inability to obtain significant shape change of the brow because of a mainly vertical vector of pull (as opposed to an upward and outward direction of lift with the open technique), and relapse. The procedure is fairly new, and so long-term results and longevity metrics remain to be established.
Dr. Capella will evaluate you for the forehead lift in the context of evaluating your facial aesthetics in their totality. This evaluation involves examining your upper and lower eyelids, your mid-facial aging, your neck, and your skin itself in addition to what is going on with your forehead. No one area of the face can reasonably be viewed in a vacuum, without consideration of the adjacent areas and the overall balance of your features.
Browlift Pre-Operative Visit
An appointment will be made to meet with Dr. Capella approximately two weeks prior to your operation. At that time you will need to discontinue medications which can lead to surgical complications, such as bleeding. Any remaining questions regarding the operation will be answered. The consent for Dr. Capella to perform the browlift will be reviewed and signed. Photographs will be taken.
Specific instructions regarding the date and time of your procedure will be given to you in writing. You will need to arrange for an escort to drive you to and from the operating suite on the day of the surgery. You should wear loose fitting clothing that will wash easily in the event they are soiled. Do not wear jewelry, contact lenses, or bring valuables to the operating room. Remove all body jewelry from pierced body parts; this can interfere with the procedure and may represent a safety threat to you because of the use of electrocautery during the procedure. Do not shave your scalp prior to surgery; this may increase your risk of infection. Appropriate shaving will be done on the morning of your procedure. Perms and bleaching should be avoided for two weeks prior to and two weeks after your browlift.
The balance of your surgical fee is due at this pre-operative visit.
Finally, Dr. Capella will write prescriptions for preventative antibiotics to decrease your risk of infection and a narcotic analgesic for post-operative pain relief. You need to inform us of any history of allergic reactions to medications.
Day Of Browlift Surgery
On the morning of surgery, Dr. Capella will need to draw lines on your face and scalp to provide him with guidelines during your procedure. Your hair will be minimally shaved appropriate to the approach used and otherwise gathered into bundles with rubber bands.
The forehead lift typically takes about an hour, and a dressing will be placed around your entire head. After an appropriate period of observation in our recovery room, you will be discharged into the company of an adult. Patients cannot be discharged into the company of a minor or to a taxi service. If you have no one to provide you with assistance, our office can make arrangements for medical transport. Out-of-town patients should plan to stay locally for approximately 5 days.
Browlift Surgery Recovery Process
You will most likely feel like sleeping for the rest of the day. Some patients may develop a headache from the tension placed on the scalp. Dr. Capella uses a long-lasting local anesthetic block to provide a measure of pain relief for several hours after surgery, but it may be necessary for you to take pain medication for about 1-3 days afterwards. You should plan to apply ice compresses to your eyes to diminish swelling and bruising. Swelling and bruising around the eye area typically resolves in less than two weeks. The dressing placed on your forehead can be removed the day following surgery and showering with mild soap is permitted two days after surgery.
You will be seen one week after surgery to assess incisions. You will then return for removal of sutures at 10-14 days. Most patients return to work at one week or less. Final results are usually evident at 3-6 weeks, though there may be some minimal swelling, which will resolve over the first three months.
Risks Of Browlift Procedures
Complications of browlift surgery can include bleeding, infection, loss of sensation, muscle weakness (with the inability to elevate the forehead), temporary or even permanent hair loss, asymmetry and recurrence of sagging brows. The longevity of the endobrow lift has specifically not been established.