Many patients want
to eliminate a tired or "angry" look in the brow area. Some
want to elevate a "saggy" eyebrow over the upper eyelids and
improve sagging in the lower eyelids. Other patients want to
lower or maintain the same brow position but eliminate the
frown lines between the eyes. Most of all, patients that
want improvement in the brow area want to be reassured that
they will not have a "surprised look."
An endoscopic browlift is performed to restore a more
naturally youthful appearance and less fatigued look while
maintaining or improving visual function. Once thought a
beauty procedure sought by only wealthy women, men in
today's competitive corporate workplace are increasingly
seeking browlift to restore a younger look that softens
frown lines and the perception of scowling.
"How do you determine if I need a browlift or just upper
eyelid blepharoplasty (eyelid lift)" Depending on the
position of the brow, a patient may need only a browlift,
only upper eyelid lift or a combination of both these
Frequently patients ask us to explain the difference between
an endoscopic browlift and a traditional forehead lift.
Along with the advantage of smaller incisions, browlifts
performed endoscopically have less chance of infection,
fewer sensation changes (less numbness and itching), less
wound care and fewer side effects following surgery. Also,
with endoscopic browlifts there is no compromise to the
hair. Not all surgeons are experienced in endoscopic
browlifts. When evaluating a surgeon, it's important to ask
not just how many browlifts he or she has done - but, how
many endoscopic browlifts have they performed.
A good surgeon, knows that his responsibility is to evaluate
not only the areas of concern but also the motivation behind
the requests. It goes without saying, a browlift won't save
a failing marriage. Similarly some patients not ready for
facial plastic surgery are better served with conservative
measures, such as Botox for fine lines and wrinkles or
Collagen for crows feet. Patients who educate themselves
about facial rejuvenation know when and if the time is right
When discussing rejuvenation procedures the best place to
start is by looking at before and after photographs to see
just what can be accomplished. As you will see in the
photos, patients frequently ask to combine a browlift with a
facelift or midface lift to elevate "laugh lines" from their
downward position and achieve a smoother contour of the jowl
area. This reduces jowling in the chin and neck area. One
benefit of a simultaneous face lift is the ability to
perform liposuction to obtain fat for patients who desire
fat injections. The most common request combines
blepharoplasty (eyelid lift) for improvements in bags under
the eye lids with browlift. Chin implants, cheek implants,
rhinoplasty (nasal surgery), otoplasty (ear surgery) and lip
surgery can also be performed with a browlift.
Many patients seek information about improving superficial
skin wrinkles. Although some improvement in facial wrinkles
can be obtained from a browlift, it will not address all the
superficial lines that come from premature aging,
overexposure to weather and genetics. Browlifts address
drooping brows; chemical peel, laser surgery and skin
resurfacing address textural wrinkles and imperfections.
At your initial consultation, your surgeon will evaluate the
bony and soft tissue architecture as well as the form and
function of the head and neck. An overall assessment of the
face provides the basis for what one may expect from a
browlift. Skin type, ethnic background and age, along with
the degree of deformity and function are important factors
influencing the outcome of an operation.
As with all facial plastic surgery, a thorough health
assessment and realistic expectations are prerequisites.
Your understanding of procedures and preoperative and
postoperative routines is essential to a successful final
preoperative appointment our nurse will provide all the
instructions for you to follow before and after surgery. On
the business day prior to the procedure we ask you to call
to confirm your arrival time for surgery. Upon arrival for
your surgery, you will talk with a nurse (who will start an
IV), discuss local anesthesia with IV sedation (you are
asleep for the surgery) and meet with your doctor before
going to the operating room. A browlift takes about two
hours depending on the underlying structure and amount of
excess tissue prior to surgery. If you are having a
combination of procedures your surgery time will take
longer. Recovery time from the anesthetic takes about an
hour and most patients are discharged about four to five
hours from the time of admission.
Please avoid any
aspirin, aspirin-containing products, or ibuprofen for one
week prior to and two weeks following your surgery. See our
"Medication List" for products to avoid prior to surgery. If
you are on any medications that affects bleeding (such as
coumadin or warfarin) please notify the office immediately.
Please refrain from tobacco products and alcohol for one
week prior and three weeks following surgery. Along with
delayed wound healing, persistent skin redness and other
complications may persist when tobacco and alcohol are not
Please notify us of all routine medications and significant
health history. We ask that you remain on your daily
medications unless instructed otherwise. At the preoperative
appointment, our nurse will tell you which daily medications
to take with just a sip of water on the morning of surgery.
At your preoperative appointment you will be given
prescriptions for use following surgery including an oral
antibiotic, antibiotic eye ointment (if you also have eyelid
surgery) and pain medications. Please obtain these
prescription medications before your surgery so you will
have them ready for use when you return home after surgery.
We will ask you to take Vitamin C (ascorbic acid), which
helps promote healing, before and after surgery.
You may not eat or drink after midnight the evening before
the procedure unless instructed otherwise. You may brush
your teeth. Your procedure will be cancelled if you do not
follow these instructions.
Remove all make-up and nail polish before arriving for your
After Browlift Surgery
When you wake up
from surgery you will notice a soft, bulky head wrap
dressing. Attached to your head dressing is a "ball" or
drain(s). The drain(s) facilitates removal of excess tissue
fluid and helps to prevent infection. Following your
browlift, the nurses will ask assist you to meet the
discharge criteria: to drink liquids, walk with a steady
gait, void, manage your discomfort, and monitor and empty
the drain(s). The nurses will review all instructions you
will need for care following your browlift. You will be
asked to come to our office (not the Surgery Center) the
following day after surgery for a dressing change and drain
removal. Although most patients describe drain removal as
discomfort rather than pain, you are encouraged to take your
pain medication about an hour prior to drain removal. You
will be asked to return in five to seven days for suture
Keep dressing dry and intact the evening after surgery.
Notify your doctor if the dressings become loose or fall
off. Monitoring the amount in the drains is very easy. Our
nurses will teach you how to manage the drains.
Following dressing and drain removal the morning after
surgery, you will notice little clips in your hair. We will
again instruct you on wound care. Cleaning the suture with a
Q-tip dipped in hydrogen peroxide and then applying the
antibiotic ointment twice a day is an essential part of the
healing process. Keep elastic wrap in place at all times for
a few days following surgery, then we will ask you to wear
it at bedtime only for about a week.
You will be asked to return to the office about seven days
after surgery for removal of clips. Because most patients
tell us their forehead is temporarily numb following
browlift, it is uncommon for patients to complain of
significant pain with clip removal.
Most patients complain of discomfort more than pain. Use
pain medication as directed/as needed. Do not drive or drink
alcohol while taking pain medication. Taking pain medication
with food helps minimize nausea sometimes associated with
Start your antibiotic (Keflex/cephalexin) when you get home
and one at bedtime. It is not uncommon to have a low-grade
fever for 24 hours following surgery.
Start swelling medication when you arrive home and at
bedtime. Then follow package directions. Take with food.
Vitamin C (ascorbic acid) helps promote healing. Take 1000
mg three times a day for two weeks following surgery.
Advance diet from
liquids to soft food to your regular diet as tolerated.
Rest for entire day
after surgery. Sleep with head of the bed elevated or use
two to three pillows for one week after surgery. Absolutely
no bending, lifting or straining. If you have little
children, bend at the knees or sit on the floor and let them
climb on to your lap. No driving for one week following
surgery. Two weeks off work is recommended.
After 24 hours, keep incisions dry except for cleaning and
ointment. Bathing is ok as long as you don't get your
incisions/hair wet. You are encouraged to shower and wash
your hair twice: once on the evening before clip removal and
once on the morning of clip removal (usually postop day
seven). Bruising can be camouflaged at one week
postoperatively with make-up. Always protect your face from
the sun. At this point, a hat and sunglasses are a good
idea. Following surgery, our staff will tell you when it is
ok to apply sunscreen, cosmetics or facial creams. Avoid
unprotected prolonged sun exposure for three months
following browlift to prevent pigmentation of incision
Your head dressing
and drains will be removed the morning after surgery. Clips
will be removed seven days following your surgery. You will
need transportation to and from these appointments. For the
first ten days following surgery, please use our private
side entrance (driveway entrance).
and disrupted sleep are very normal postoperative symptoms
and will decrease as the healing process occurs. Assistance
with daily activities the first two to three days after
surgery is strongly recommended.
it takes time for the swelling to subside and for the skin
to heal. Most patients return to work two weeks following
surgery, however three weeks is ideal, depending on the
degree of privacy one is trying to maintain. At three weeks
postoperatively, swelling and bruising may be apparent to
you but not to many of your coworkers and closest friends.
Final results following browlift are not apparent for one
full year following surgery. After three months, the changes
are ever so subtle, although still important. Being
perfectionists about our work, you may tell us you are
pleased long before the one year anniversary. However, we
request that you follow-up with us at that time for
postoperative photographs and so that we can enjoy your