Each year the number of individuals who undergo cosmetic surgery increases at an incredible rate. The brow lift is becoming more and more popular. The social and economic influences, which place emphasis on “appearances”, are quite evident at both ends of the age spectrum. Younger people seek peer acceptance; older people face their own challenge in maintaining positive attitudes for an extended period of time.

 

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(Brow Lift, Lower Blepharoplasty, Anterior Neck Lift)

Cosmetic surgery can truly satisfy many needs and often will provide that extra measure of inner confidence that might otherwise be difficult to achieve. It requires no apologies and is understandably accepted in all circles. It is, however, not the answer to all of life’s problems. The purpose is to improve one’s appearance as much as may be possible. It can do no more, and if one expects a transformation, they will be disappointed.
   Most patients understand these limitations and view the potential benefit realistically, and if generally healthy, emotionally stable, and properly motivated, are good candidates for cosmetic surgery. Under these circumstances, the true objectives can be accomplished and yield final results that are predictably accurate.
    The decision to undergo any surgical procedure is one that must be made by the patient alone and should not be undertaken solely at the suggestion or at the encouragement of others. On the other hand, well meaning friends or relatives sometimes misinterpret the patient’s desire for assistance and express negative attitudes without basis. However, if those persons understand that improved self-confidence is the essential need, and if their interest is truly in the patient’s behalf, they will be supportive.

 

Brow lift, Upper & Lower Blepharoplasty (Post-Op)

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    While the patient’s specific desires will be given important consideration, the method of achievement requires professional judgment in evaluating functional and aesthetic goals within the anatomical limitations.
   The purpose of this brochure is to inform you of the fundamental concepts and bring to your mind questions, which I will be happy to answer. Also, it will permit careful review of this information at home, apart from the office atmosphere where anxiety or embarrassment may be overriding, and perhaps distracting. It may also be useful as a reference in discussion with family members who cannot be present at the time of consultation. It should be understood that its sole purpose is information.
   In contemplating any corrective surgery, you need not be apprehensive or approach any procedure with fear. With present methods of anesthesia, there will be essentially no pain or discomfort during the operation and usually only moderate discomfort, which can be easily controlled with pain tablets for a short time afterward.
    It should be understood that during the examination and preparation for surgery, the surgical procedure itself, and during the follow-up care, competent individuals, who will play an active role, would assist me. My personal attention will be directed to all of the important details, and every effort will be made to obtain the best possible result. Also, every patient must play a part in his or her own treatment by adhering strictly to postoperative instructions. This is just as important for the achievement of the best results as is an excellent performance on the surgeon’s part. Although I am committed to doing the best job possible, as with any surgery, the results are not guaranteed.
GENERAL INFORMATION
   The forehead lift is done to help eliminate frown lines on the forehead and to correct the drooping of the eyebrows, which often give the patient a constant “angry “ expression. These changes can be related to age, heredity, or environmental factors. Not everyone ages at the same rate. A great deal of the aging process relates to your tissues and what you do to care for them.
   This is considered a minor operative procedure. Like any extensive surgical procedure, operative incisions and complicated surgical stitching are required. Also, contrary to some non-medical reports, it is NOT possible to remove ALL the wrinkles and lines in the skin, regardless of the treatment applied. You must accept the judgment of your facial plastic surgeon and realize that he will only remove the skin of the scalp that can be done safely and is suitable for your particular facial contour. The forehead lift procedure is directed toward improvement, and cannot in any way guarantee that each and every wrinkle and fold of the forehead will be removed. The type of skin and age of the patient are important factors in the final result.
   Along with the development of better surgical methods, there has been a significant change in opinion concerning the optimum time for facial surgery. There is no need to wait until there are hanging folds or almost irreversible changes have taken place. While correction is perfectly possible in the late sixties or seventies, over stretched muscles with time, particularly in the eyelid region, become difficult to repair. Preference has shifted to the early forties, or perhaps earlier under some circumstances, when limited correction can often be made to maintain a youthful appearance for an extended period of time. The selection of patients in the earlier age group must be based upon the character of tissue aging and the degree of improvement that might be anticipated.
   Frequently, in combination with a forehead lift, other procedures may be necessary to correct the patient’s particular problem. Specifically:
1. A face-lift may be done to remove the large wrinkles and loose skin about the face.
2. The excess fat in the neck area may need to be removed, along with adjusting the skin muscles to re-contour the area under the chin.
3. Sometimes, it is desirable to place a small silastic implant into the chin, to improve its prominence, and make it more harmonious with the remainder of the facial contour.
4. Often, it is necessary to do a blepharoplasty, or eyelid surgery, to reduce the bagginess in the upper and lower eyelids.
5. It occasionally may be necessary to elevate the nasal tip slightly to create a more youthful appearance.
6. A Co2 Laser face peel, or sometimes laserbrasion, is done to diminish the fine wrinkles, particularly around the mouth, and the “crow’s feet” around the eyes, that are not removed by the face lift, the forehead lift, or eyelid surgery. Some of these procedures can be done in conjunction with a forehead lift. Others will be done at a later date, if necessary.
   Generally, the entire operative procedure, with all its modifications, has been extremely successful, and has provided significant personal satisfaction to many individuals. Apart from the specific risks noted, the procedure is not hazardous to the patient’s physical well being and can be recommended as an appropriate solution to many of the aging signs that some individuals find objectionable. Please remember that the patient must follow postoperative instructions carefully in order to achieve the very best results.
PROCEDURE
   The operation is usually done in the office or ambulatory surgery setting after which the patient returns home. This choice is the patient’s unless there are some other medical problems existing, which would make it necessary for the procedure to be done in the hospital.
ANESTHESIA
   Local anesthesia plus sedation just prior to surgery helps the patient to be completely relaxed. The operation itself should not be painful. The operation can be done under general anesthesia with the patient totally asleep.
SURGICAL TIME
   Approximately two hours or longer, when combined with other procedures such as those listed above.
SURGICAL PROCEDURE
   Prior to surgery, the patient is instructed to shampoo the hair with soap. This is done the night before, and possibly the morning of surgery. A incisions for the forehead lift are very tiny and behind the hairline. No hair is removed for this procedure. The procedure is normally done endoscopically. In addition, it must be pointed out that the forehead lift does raise the hairline slightly, giving the patient a higher forehead and this must be taken into consideration. This usually is of no consequence unless the patient already has a high forehead. After the incisions are made, the skin is released from the underlying tissues, pulled on the proper lines of tension, and the brow pulled to a normal tension. There may be small temporary tubes coming out through the skin, which are drains, to help prevent blood and fluid from collecting. The incisions are then closed with surgical stitches. In some cases, either a mid forehead or direct brow lift may be performed where incisions are made on the forehead, but are hidden in the forehead wrinkles.
DISCOLORATION AND SWELLING
   The patient can expect some swelling of the face and eyelids, and some discoloration is common with any type of facial surgery. This is usually most noticeable on the second and third days, and diminishes in approximately twelve days, depending on the patient’s type of skin, age and healing ability.
POSTOPERATIVE CARE
   Hydrogen peroxide and Polysporin ointment will be used on the suture lines. These can be purchased at the drugstore prior to surgery. A scarf may be worn to cover the stitches until they are removed. The patient is requested to remain within a reasonable traveling distance to the surgeon’s office for approximately ten days. Icepacks for 48 hours may be useful to keep bruising to a minimum.
COMPLICATIONS
   Even in a well performed and controlled operation, there may still be some limited blood collection under the skin. This can be treated during the follow-up office examinations and will not affect the overall results. Larger collections require early and more vigorous treatment, and possibly the re-opening of part of the surgical incision to remove clotted blood or to close small bleeding points. This complication is unusual, however. There may be temporary lag in the normal motion of the facial muscles of the forehead, but rarely is this permanent. Most often, the delay is due to swelling, and will gradually subside without permanent change.
   A number of other conditions must also be anticipated in the early postoperative period. There will be a feeling of numbness and tension in the forehead and front area of the scalp. This is the result of separating the skin from the underlying tissue that divides small sensory nerve fibers in the skin during the operation. There usually is a small area just behind the scar in the scalp that has permanent decreased sensation. This will usually disappear during the first four to six months after surgery. Swelling and bruising of the skin varies, but usually lasts approximately 10 to 14 days. It subsides gradually during the early postoperative period, leaving no ill effects. Temporary swelling around the eyes is also not uncommon shortly after the forehead lift. Scarring may also be a complication when the incision is placed on the forehead, especially during the healing process.
SCARS
   The surgical scars are permanent; however, they will not be noticed because they are back within the hairline. If a mid forehead or direct brow lift is performed, a period of two to three months may be required before the scars begin to fade.
SHOWERS AND BATHS
   No restrictions. Be careful if using a hair dryer or any electrical applicance on or around the face..
SOCIAL ACTIVITIES
   Social activities should be limited for approximately two weeks following surgery. Strenuous activities should be avoided for four weeks.
FEE
   It is customary that fees for cosmetic surgery be paid in advance of surgery. Fifty percent of the fee is required at the time of surgical scheduling; the remaining fee needs to be paid at least one week prior to the surgical date. If the fee is not paid by one week prior to the scheduled time of surgery, it will be necessary to cancel the surgery, so another patient may utilize the time.