1) How do I know if I need an upper eyelid lift or a browlift?
It depends on the position of the brow. During the initial consultation to evaluate the upper eyelids, the surgeon uses his hands to raise the patient’s forehead skin to an appropriate level. When the forehead skin is raised, if most of the upper eye lid skin disappears, a patient would most likely benefit from a forehead lift. If raising the forehead skin has little or no effect on the upper eyelid skin, an upper eyelid lift (blepharoplasty – pronounced bleff ar oh plasty) may be all that is in order. If improvement is noted when the brow is lifted and excess skin remains on the eyelids, a combination of browlift and upper eyelid blepharoplasty may be recommended.
Look at the Before and After Photo of the patient who had a browlift. She had no upper eyelid skin excised. In this case, browlift alone was effective because the actual source of her concern was a droopy brow. (Droopy brow is also known as brow ptosis.) Compare that with the Before and After Photo of the patient who had upper eyelid blepharoplasty and no browlift. In the preoperative photo you will see that this patient’s brow had not fallen, therefore removing upper eyelid skin alone was effective.
2) If I have a browlift, will I end up with a “surprised” look?
First things first – a browlift does not automatically mean that the brow will be elevated. A browlift can be performed to lower the brow, to raise the brow or retain the same brow position.
Second, it’s not uncommon for patients to see themselves with a “surprised” look for up to three weeks following browlift. This surprised look can result from temporary swelling. After three weeks a patient may continue to see this look as a very noticeable change, yet others are completely unaware of it. Browlifts can raise OR LOWER the brow. An experienced cosmetic surgeon knows the essential combination of the correct position of the brow and the result that the patient is trying to achieve.
3) What does “endoscopic” browlift mean?
Endoscopic browlift means that your surgeon is using a telescope about the diameter of a pencil eraser to perform the surgery. When the telescope is inserted under the skin, the area is displayed on a television screen.
Endoscopic browlifts have several advantages. First, endoscopic browlifts allow the surgeon to address the brow, upper eyelids AND a portion of the lower eyelids. One of the most common requests – eliminating the “angry look” or frown lines (created by the corrugator muscles) between the eyes – can be addressed with the endoscopic approach. 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.
4) How long does a browlift last?
As with facelifts, the longevity of the benefits of a browlift are dependent on several factors. For patients who do not smoke, do not abuse the sun, are in good general health and have good genetics, a browlift can last five to ten years. For patients who elect to abuse their skin and body, a browlift will only last up to five years.
5) What’s the difference between endoscopic browlift and midfacelift?
Endoscopic browlifts have the ability to raise or lower the brow and address the upper and part of the lower eyelids, stopping at the bony rim (called the zygoma – Zi go ma) below the eyes. If a midfacelift is also performed, the surgeon is able to provide middle face rejuvenation -including any remaining portion under the eyes and the area of the face level with the nose down to the teeth. With the addition of a midfacelift, the cheek is elevated, it pads the bony rim of the lower eyelid thus necessitating less fat removal. This improves our ability to treat lower eyelid “bags” and rejuvenate the bony orbital rim by precisely treating the droopiness and bagginess about the eyes in the manner that it ages. See Before and After Photo to compare area below eyes.
6) Will I still look like “me” after surgery?
Many of our patients report that, upon return to work and routine daily activities, friends and acquaintances make the following remarks: “Gee you look great. Did you change your hairstyle?” or “Have you been on vacation?” Retaining your uniqueness is the sign of a successful procedure. Although the change may be significant to you, it’s not uncommon that friends and family don’t really notice the specific changes.
7) I want to dramatically change the appearance of my brow. Can I do that?
This is an excellent question because it leads to evaluating realistic expectations. This question can only be answered on an individual basis. A sign of a good surgeon is one who can tell the difference between realistic and unrealistic expectations and one who will be truthful about meeting each patient’s desires.
8) Will a browlift get rid of these deep frown lines between my eyes?
Yes. As we stated above, frown lines are one of the most common reasons that patients seek browlifts. Patients tell us about hearing comments such as “she looks angry” when, in fact, they are very good natured. Frown lines are more often the effect of the corrugator muscles and premature aging. Some of the deepest lines may not completely resolve, however they will be significantly improved. Adding a finishing touch with filler or resurfacing options provides optimal results.
9) Will a browlift get rid of the horizontal wrinkles in my forehead?
As we age, our skin looses its elasticity. A browlift is most often performed to relocate the brow and restore it to a more youthful position. A browlift will not remove fine lines and wrinkles in the skin as a result of aging, sun, tobacco abuse, etc. Frequently patients elect to have skin resurfacing (such as CO2 laser) at the time of the browlift to address both concerns.
10) How much pain will I have?
Most patients who have browlift surgery say how surprised they are that the pain is less than they anticipated. Understandably, after any surgical procedure, some discomfort can be expected. All patients are provided with prescriptions for pain medication. Patients sometimes use the prescription medication four to five days after surgery. Patients undergoing a midfacelift will have some pain on chewing for about 48 hours. It is uncommon for patients to report unmanageable pain after surgery.
11) If I have a browlift will it also lift my face?
As we described above, browlifts have the additional benefit of addressing the area below the eyes. When combined with a midfacelift suspension, which can be performed through the same incisions, the procedure does lift some sagging in the face. See the Before and After Photo of the patient with a browlift alone. A midfacelift will not, however, address one of the most common concers of cosmetic patients which is the “turkey wattle” (that thing that hangs down from a turkey’s neck) to tighten the neckline
12) Where are the incisions for endoscopic browlift?
The beauty of the browlift is that it is done endoscopically. The incisions are approximately one half to one inch long, all hidden in above the hairline. Because of incision placement, browlift incisions heal very well and most patients and family members will not notice them after a few weeks.
13) What if I have a history of bad scars?
If you have pierced ears, the way you healed there is a good indication of how you will heal from facial plastic surgery. Scars on the rest of the body typically are not an indication for how patients heal following facial plastic surgery. At the time of your consultation, it’s important to show your physician any previous scars (keloid scars) that are of concern to you so he can give you a realistic assessment of your healing potential following facial plastic surgery.
14) Will I be awake during surgery?
Patients are asleep using IV sedation (medicine administered through an IV) and a local anesthetic (numbing medication administered in the operating room). Patients do not hear or feel anything and are comfortable during the operation. Patients wake up very soon after the surgery is completed. Intravenous sedation is a type of anesthesia; therefore all patients must have a responsible adult to stay with them through the night following surgery. Patients may not drive for seven days following their procedure and this time may be longer, depending on the procedure.
15) Do I go home after surgery?
Most browlifts are done on an outpatient basis. Because you will go home after receiving sedation, you will need to make arrangements for a responsible adult to drive you home, to stay with you overnight and to drive you to our office for your first postoperative appointment.
16) How long will bruising and swelling last?
Postoperative bruising and swelling begins to resolve at the end of the first week. Full resolution of bruising or swelling may take two to three weeks. However, you may camouflage bruises fairly easily at seven to ten days with concealer stick.
17) When can I go back to work?
Restrictions from work are generally two weeks for browlift surgery. Because initial surgery swelling may still be present, patients who are more concerned with privacy about the procedure take three weeks off to be safe.
18) When can I “work out?”
Aerobic activities should be avoided for three weeks following surgery. Any activity that potentially increases blood pressure will increase the amount of time it takes for postoperative swelling to resolve.
19) I want to know details about the procedure.
Glad you asked! the preoperative and postoperative instructions are listed below.