With the recent popularity of the new plastic surgery makeover television shows, the term “facelift” is being used to describe a plethora of operations. We are seeing a growing number of patients who think that just because of their aging conditions, they need a facelift. A facelift addresses the sags in the cheek and neck areas. However, we begin to show signs of aging earliest in the upper third of the face (brows and eyes). After all, the eyes are the focal point of visual contact. Any changes in the brow and forehead regions affect the eyes and cause us to either look tired or angry. The earliest sign of aging is sagging of the outer third of the eyebrow as it begins to droop. This sagging causes the upper eyelids to bulge and push down to lie on top of the eyelashes. Most patients have one of three complaints: their eyes appear to be getting smaller or are deeper set, they look sad, tired or angry even though they do not feel this way or their mascara finds itself high on the upper lid within a short while of being applied. Some say all three sound familiar!
Who Is A Candidate for a Brow Lift?
To do a self-consultation and analysis on your own brow, simply place the hands above the brows and outside the edges of the eyes and lift upward. You may be surprised to see how much a small amount of lifting “opens up the eyes.” Ideally, the eyebrow should rest slightly higher than the brow bone in women and at the brow bone in men. When the brows have dropped below these landmarks, then it may be time to consider a brow lift. Another poorly understood concept is that the brow actually droops in different areas and usually does not sag uniformly. If the outer edges sag, a person tends to have a sad look. If the inner edges sag, this causes the deep furrows above the nose and between the eyes and can give you a concerned or angry look. When the brows fall evenly across the face, you may have a tired look. If any of these conditions are improved with your self-consultation, then you may be a good candidate for a brow lift. Once the brow starts to droop, the natural tendency is to keep the brow elevated by using the forehead muscles. This is our own method of compensating for droopy brows. It would work great except for the fact that when you overuse the forehead muscles, this causes the horizontal lines across the forehead to appear earlier. These are the lines that are most commonly treated with Botox. The goal of a brow lift is to elevate the brows – not remove these lines. If the brows are pulled so tight that these lines are totally removed, then the brows have an unnatural appearance – the infamous “surprised” look. These lines may be lessened with a brow lift, but not totally removed. A resurfacing procedure such as laser or dermabrasion may be performed at the same time as brow lift surgery to improve the horizontal lines across the forehead.
About the Procedure
Our primary goal is to give you a natural appearing brow position and brow shape that fits your face. This can be achieved through three different methods that differ only in the site of the incisions. For patients with low hairlines and no hair loss, an uninterrupted incision may be placed behind the hairline. This technique raises the brow and also advances the hairline backwards. We recommend this only in those patients who can afford to have their hairlines raised. A second technique is one in which the incision actually follows the hairline and is made so that the hair grows through the scar. Not only can we raise the brows, but we can also lower the hairline to a more youthful position in patients with receding hairlines! This scar eventually blends to the point that the hair camouflages it. The third method involved a technique that has been popularized over the past ten years called the endoscopic lift. As with all operations, it had its problems early during its introduction, but these appear to have been corrected and leaves the patient with smaller scars, less “down time” and predictable results. All of the above techniques will be discussed with you during your consultation. We will then decide which technique best suits you based on your brow position and hairline. The most commonly asked question about brow lift surgery is, “do you shave my hair?” The answer is no. We have tailored our operation so that no hair is shaven in any of these procedures. Brow lift surgery may be performed under twilight anesthesia and patients are allowed to go home on the day of surgery. Now that you have learned the obvious benefits of a forehead lift, there are three “bonuses” to a brow lift that most patients don’t realize initially. Many patients will get substantial improvement in their “crow’s feet” when their brow is lifted. Also, with an extended dissection down in to the cheek area from the forehead incision, a cheek lift can be performed without having to place any incisions on the face. Finally, the corrugator muscles which are the vertical lines above the nose and are better known as the “Botox muscles” may be debulked so as to lessen the reappearance of those frown lines.
Even though the recovery period technically starts immediately after surgery, there are several things that you can do before your surgery day to make the recovery period smoother. During your consultation, we will talk to you about the importance of being physically and mentally prepared for surgery to ensure that we get the best results possible. Now back to the recovery period. Immediately after surgery, a compression dressing will be placed around your head over your brows. This dressing will be removed the following morning. Most patients go home the day of surgery if brow lift surgery is the only procedure performed. Once the dressing is off the next morning, you may shampoo your hair being careful around the incision sites. The first day after surgery is strictly a “bed rest” day. You may feel better than expected, so the temptation is to “over do” it on this first day. However, patients have less bruising and swelling if they rest with their head elevated on the first day. Swelling is typically mild to moderate reaching its maximum on the third postoperative day, and then it starts to decline as it moves down the face. We allow you to resume normal activities and also apply makeup by day four. Stitches are removed on day seven, and we try to have you presentable to the general public by day seven to ten.
Bruising is expected after any kind of surgery. The amount that you bruise is extremely individualized – some people will bruise more than others. However, with every patient, we can expect a reduction in the amount that you bruise by taking Bromelain during the preoperative and postoperative period. We encourage you to drink at least 8 glasses of water each day during your recovery period to flush the bruising out of your system. Our experience with browlift surgery is that the combination of Bromelain and water intake will reduce the amount of bruising that you normally would have had. During the recovery period, you will notice that your bruising changes colors. All bruises initially appear red and change to a purplish hue. By day five, the majority of your bruises will have changed to a green and then yellow color. Once you have reached the yellow stage, you are almost “bruise free.”
Just like bruising, expect swelling. The day after surgery, once the dressing is removed, swelling will actually increase over the next day. Typically, swelling begins to decrease on the third day after surgery. We often get the question, “what can I do to reduce swelling?” You will be scheduled during the recovery process for a procedure called lymphatic massage, which works to reduce swelling. Our aestheticians are trained to manually massage the swelling out of your face and into the neck area. Lymphatic massage has been proven to significantly reduce postoperative swelling. I usually do not recommend ice packs. Remember that there will be areas on your brow that are numb initially after surgery. You can actually “freezer-burn” your skin if you have an ice pack over an area that is numb.
It is best to sleep in an upright position with your head at least above the level of your heart for the first two weeks after surgery. This helps to reduced swelling and also bruising. The best beds are usually either a recliner or an incline pillow. Both of these keep the head and shoulders in a natural position. If you try to sleep with your head elevated with pillows, you wind up sleeping in an unnatural position and develop muscle spasms in your shoulders.
You may begin light walking on the fourth day after surgery. In fact, we usually encourage this because it helps to improve your circulation, which in turn gets rid of bruising and swelling quicker. You can gradually increase the intensity of your walking over the next few days as your body tolerates it. Your body will tell you how much exercise is enough. We usually recommend that you refrain from any competitive sports such as tennis or golf for at least two weeks. When it comes to exercise, don’t pull against any tight sensations that you may have.
A popular question is “how much pain will I have after a browlift?” Most patients will tell you that they had little to no pain after surgery. The common response is that everything felt “tight.” This is usually due to swelling and the tight sensation begins to subside after about 2 – 3 weeks. Patients are given prescriptions prior to surgery for pain medicine and are encouraged to take theme as directed for discomfort. However, most patients switch to Tylenol soon after surgery.
Patients may eat whatever they feel comfortable eating. The day after surgery we usually recommend that you gradually progress back to your normal diet. For the first 24 hours after surgery, the anesthetics will still be in your bloodstream, which may cause you to get nauseated easily if you over eat. Patients are just encouraged to stay on a soft diet for this first 24 hours.
When Will I Look Presentable?
Obviously, this is a very individualized answer. The average patient is able to go back in public without being obviously swollen or bruised by about 5 – 7 days.