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A browlift (forehead lift) procedure is performed to elevate the eyebrows and to reduce or eliminate wrinkles and creases from the forehead. Aging and gravity tend to pull the eyebrows down, especially laterally, resulting in a "sad" or tired appearance. As a reflex you tend to elevate your eyebrows using the muscle in your forehead. This accentuates forehead wrinkles and creases. There may even be excess skin of the upper eyelid giving the impression that one needs to have the upper eyelid skin removed (blepharoplasty). By surgically elevating the eyebrows to a more normal position, an "open" almond-shaped appearance of the eyes is achieved. By elevating the brows an upper blepharoplasty may not be necessary.
Surgery The browlift procedure was, until a few years ago, performed through an incision completely within the hair of the scalp extending from one ear to the other. This incision is seldom used now. Today, several small incisions are made in the hairline, just above the forehead. An endoscope (a telescope with a lens, light source and camera attached) is used to assist in visualization so smaller incisions can be made and consequently less scarring occurs. The muscles of the forehead are cut to weaken them, thus reducing forehead wrinkles. The forehead skin is shifted up and back to elevate the eyebrows. Suspension sutures are used to maintain the elevated position. This procedure is often performed in conjunction with other procedures to rejuvenate the entire face since all components of the face age simultaneously. Anesthesia The procedure is performed under general anesthesia or under heavy sedation and local anesthesia as an outpatient. If you have other procedures done at the same time you may stay at the surgical facility overnight, or in a nearby hotel with a private nurse. If the browlift is the only procedure performed you will return home on the day of surgery. The anesthesiologist and the surgical facility will bill separately for their services. Duration of Surgery The operating time will vary depending on the patient and the extent of the procedure, and whether any additional procedures are performed. Generally, the time is approximately 1 hour. Before Surgery Do not take aspirin or products that contain aspirin for at least 3 weeks prior to surgery. Also refrain from any herbal supplements, as some may have an effect on increasing bleeding during the course of surgery. Remove all makeup and mascara from your eyelids. If you wear contacts lenses, it would be preferable that you wear glasses when you arrive to the surgery center.
After Surgery A light dressing is applied after the procedure to give gentle compression to the operated areas. Ice packs will also be applied to help reduce bruising and swelling. There is usually a moderate amount of swelling and bruising after a browlift. You may experience swelling of the upper eyelids that may result in not being able to open your eyes completely. This swelling should dissipate in 2-3 days. You should try to sleep with your head and shoulders elevated, in an effort to help reduce the amount of swelling. You may shower once the dressing is removed, usually within 48 hours after surgery. If you bathe, do not allow the incisions to soak under water. You may remove the elastic support to shower or bathe. Initial discomfort is controlled with oral medication. The stitches or staples placed are usually removed in 10-14 days. You should apply antibiotic ointment (Neosporin or Polysporin) to the incisions twice daily. Return to Normal Activity Most people return to their usual activities and to work approximately 1 to 2 weeks after surgery. It is acceptable to apply makeup after 3 to 5 days. Strenuous sports and other activities should not be performed for 3 to 4 weeks. You may drive when the swelling goes down (3-4 days), or when you are no longer taking pain medication. Photographs Photographs are taken at the time of your consultation. These are important aids in the preparation of surgery and become a permanent part of your record. Post-surgical photographs are also taken. Scars You should expect several scars (usually 3), each about ½ inch behind the hairline above your forehead. Each incision is usually no larger than ¼ inch. The location will vary somewhat depending on the hairline. Most scars will be covered by hair. All scars are however permanent. The width, height and color of scars are unpredictable. Wear sunscreen of at least SPF 30 or greater when outside to protect the scars from sunlight during the healing process. You can improve on the scars by massaging with Vitamin E. Diminished Sensibility As with any surgical procedure, small sensory nerves to the skin surface may be cut when the incision is made or when skin is undermined. Portions of your forehead and scalp will feel numb or have less than normal feeling. The sensibility in these areas gradually returns, usually within 2 to 3 months as the nerve endings spontaneously heal. During the healing process the forehead and scalp may become hypersensitive for a period of time. Some diminished sensibility may last indefinitely. Swelling and Bruising Swelling and bruising of the forehead and face or any surgical site following surgery is normal. During the first 1 to 2 weeks your forehead will feel and look swollen. The swelling will start to subside during the first week. It may take as long as 2 months for the last bit of swelling to recede.
Complications
HEMATOMA This is the most common complication and occurs when a collection of blood forms under the areas of undermined skin. It occurs in about 1 to 2% of patients and is more common in men. The body will absorb minimal bleeding. A larger collection may necessitate aspiration to drain the collection. Occasionally it will require additional surgery. EDEMA {Swelling) This is a normal consequence of surgery and is best treated simply by elevating the head of the bed. The applications of ice packs or cold compresses over the eyes are usually helpful for the first 1 to 2 days. ABNORMAL SCARS A small percentage of patients will develop scars that are unacceptable despite meticulous attention to detail both during and after surgery. The scars may widen, stay red or raised. In some cases hair may not grow around them. If the scars are problematic, a steroid ointment or injection may be used to improve their appearance. In some cases the scars need to be revised surgically. INFECTION This complication is also rare. Prevention is the key and antibiotics are given both before and for a period of time after surgery. ASYMMETRY There is usually some asymmetry of the brows, in some people this is marked and is the reason they seek surgery. All efforts are made to have the eyebrows as symmetrical as possible. A slight asymmetry may be acceptable after surgery. A greater amount of asymmetry may require additional surgery to correct.
I mention these complications not to alarm or frighten you since the usual outcome after this surgery is quite favorable. The majority of patients are very satisfied. I present this information to you to fully educate you on the side effects, undesirable sequelae and complications no matter how remote they may be.
Dr. Morales Recommends Theraderm Skin Products for his patients before and after surgery.
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