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A forehead lift or “brow lift” is a procedure that restores a more youthful, refreshed look to the area above the eyes. The procedure corrects drooping brows and improves the horizontal lines and furrows that can make a person appear angry, sad or tired.
In a forehead lift, the muscles and tissues that cause the furrowing or drooping are removed or altered to smooth the forehead, raise the eyebrows and minimize frown lines. Dr. Sundine may use the conventional surgical method, in which the incision is hidden just behind the hairline; or it may be performed with the use of an endoscope, a viewing instrument that allows the procedure to be performed with minimal incisions. Both techniques yield similar results — smoother forehead skin and a more animated appearance. Brow lift surgery is sometimes performed in conjunction with Orange County eyelid lift for a refreshed look.
Your Brow Lift will be performed by Dr. Michael Sundine at his office located in Newport Beach and Beverly Hills
Brow Lift Questions and Answers
How do I know if I am a candidate for a brow lift?
Patients who are candidates for a brow lift (or forehead lift) present with several different complaints. Many of them will present saying “My friends tell me I look tired and sad and they ask me if something is wrong.” They may also say “People ask me what I am angry about because I look annoyed all of the time even when I am in a good mood.” Patients will have heaviness of their upper eyelids and may think they need their eyelids treated. When the outer brow is lower than the inner brow it conveys a sad appearance to the face and when the inner eyebrow is depressed relative to the outer brow it communicates an angry or annoyed appearance. Other patients who are candidates for a brow lift may have deep wrinkles across their forehead or in the area between their eyebrows.
How can you tell whether I need my upper eyelids treated or my forehead?
With careful examination we can decide whether the forehead needs to be treated versus the eyebrows or possibly both. With the patient seated into the upright position we place the eyebrow position that is pleasing and natural appearing. When the eyebrow is in this natural position the skin and fat of the upper eyelids can be assessed. Frequently patients present to us thinking that they need their upper eyelids treated when, in fact, they really need their eyebrow treated. It is especially important to evaluate the eyebrow in males who present with heaviness of their upper eyelids. If an excess amount of skin is removed in males to compensate for the sagging eyebrow it may result in a feminized appearance of the upper eyelids.
Where are incisions placed for the brow lift?
There are several different sites where incisions can be placed for a brow lift procedure. Determining the site for the incision is based on several factors. Especially important is the level of the current hairline and the amount of elevation required with the brow lift. The potential incision sites include the direct brow lift, indirect brow lift, midforehead lift, endoscopic brow lift, and the open brow lift.
The direct brow lift is essentially reserved for bald males where the patient does not have a hairline to hide the incision. The incision for the direct brow lift is just above the eyebrow and is very effective in lifting the eyebrow. The procedure can be performed under local anesthesia alone and may be applicable to patients who need their brows elevated to improve their vision but who may be too sick to undergo a more extensive procedure.
The indirect brow lift is essentially the same as a direct brow lift except that the incision is placed such that a scar is placed directly into a forehead crease above the eyebrow.
In the midforehead lift the incision is placed such that the scar is placed to line up into a crease in the middle of the forehead. We try to avoid the direct, indirect, and midforehead lifts except in very limited circumstances because of the possibility of visible scarring.
In the endoscopic brow lift there are typically three incisions made just behind the hairline in the forehead and a slightly larger incision made in the temple area. Using these incisions the forehead tissues are freed up over the top of the bone. The tissues are then repositioned upward and are held in position using a variety of fixation methods.
In the open brow lift the incision may be placed in several locations based on the amount of elevation required and the hairline. The incision is hidden within the hair or at the hairline. The scalp and forehead are then elevated and repositioned upward. The extra scalp is then trimmed and the scalp is sutured upward.
What type of anesthesia is used for a brow lift?
Dr. Sundine typically uses general anesthesia for his brow lift procedures. In some cases the procedure may be performed under local anesthesia with sedation.
How long does it take to perform a brow lift?
Typically it takes 1 ½ to 2 hours to perform the procedure.
Do I need to go to the hospital for the procedure?
The procedure is performed on an outpatient basis in a fully accredited outpatient surgical center. The center is staffed only with board certified anesthesiologists.
What are the alternatives to a brow lift?
Really the only alternative to a brow lift is botulinum toxin (eg. Botox). The use of botulinum toxin can paralyze the muscles that lower the inner and outer aspects of the brow. The muscle that raises the brow can then work unopposed. The effective lift from botulinum toxin is mild, however. Patients with brow ptosis (sagging of the brow) will find that the heaviness of the brow may become worse if botulinum toxin is used for their forehead wrinkles because the muscle that keeps the brow elevated has been paralyzed. The problem with botulinum toxin is that the injections need to be repeated approximately every 3 months.
Will I have scars from the brow lift?
As with all surgical procedures there is some scarring from a brow lift procedure. However, the incisions area all designed such that the scars will be hidden within or at the hairline.
What are the potential risks or complications associated with having a brow lift performed?
As with all surgical procedures there are potential risks associated with the surgery. Some of these risks include bleeding, scarring, hair loss near the incisions, nerve injury, numbness, asymmetry, need for additional surgery, and anesthetic reactions. Overall, the risks of a significant complication are quite small.
What happens after the brow lift is performed?
The brow lift is an outpatient procedure. Typically most patients go home with a family member or friend. Recovery at an aftercare facility can be arranged if needed. Virtually all patients have a drain placed that is removed the next day. Patients are asked to use ice and keep their head elevated to reduce the amount of swelling for the first 5 days. Patients may shower and wash their hair on the first postoperative day after the drain has been removed. The sutures are removed on postoperative day 10.
How much bruising, swelling, and pain is there?
Generally there is not a lot of bruising or swelling in the forehead but this does tend to settle into the upper eyelids. The swelling peaks on the second postoperative day and then goes down from them. There is mild discomfort associated with the procedure that is well managed with oral pain medications.
Could I need to have another brow lift in the future?
Unfortunately aging and gravity are never ending and it is possible that a patient may require another brow in the future. Interestingly, according to the plastic surgery literature the recurrence of brow ptosis (sagging of the eyebrows) is higher with an endoscopic brow lift as compared to the open procedure.
When can I resume exercise following the brow lift?
On the evening after the procedure you should have minimal activity and rest with your head elevated and ice for swelling. You may do some light walks and go up and down stairs starting on postoperative day 1. You should be able to return to full activity starting at three weeks postoperatively.
When can I return to work?
You could potentially return to work at about 10 days postoperatively but you should really plan on taking a couple of weeks off.
Will insurance cover the costs of the procedure?
Typically insurance does not cover the costs of a brow lift performed for cosmetic reasons.
Over the years, many plastic surgery Orange County patients have visited the practice of Dr. Michael J. Sundine, a renowned surgeon with more than 23 years of experience. Offering a range of procedures for the face, body and breasts, Dr. Sundine specializes in facelift, blepharoplasty and rhinoplasty in Orange County. To learn more about the procedures available and schedule a consultation, contact his practice at 949 706 3100.
Browlift After Care Instructions
- After surgery keep your head elevated on a wedge pillow. While awake in bed flex your feet and legs 4-6 times every hour. When getting out of bed to go to the bathroom, do so only with assistance, especially if your eyes are swollen.
- Apply surgical pads or ice bags (crushed ice is best) over the forehead and eyelids as much as possible during the first 72 hours after surgery, as this will reduce the amount of swelling you will have. DO NOT SMOKE! Smoking can cause poor wound healing and my result in bad scarring.
- For the first 72 hours please avoid any type of straining. However, it is good to get out of bed and sit in a chair after surgery. You may go for a light walk and may go up and down stairs following the procedure.
- If you have discomfort/anxiety, take the medication prescribed as directed. It is best to take the pain medication with crackers, Jell-O, etc. Do not take pain medication if you have no pain. Do not drink alcohol while taking the pain and/or anxiety medication.
- A light diet is best for the day of surgery. Begin by taking liquids slowly and progress to soups or Jello. You can start with a soft, regular diet the next day.
- You can expect swelling of the face and eyes after surgery. If the swelling on one side is definitely more pronounced than on the other side or if you having pain that is NOT relieved by the pain medication, call Dr. Sundine at 949-706- 3100
- If your eyes feel dry, use a tear substitute as you need it to keep your eyes moist and comfortable. (Refresh Plus is excellent; you can buy it over the counter and you can use it every 30 minutes if needed)
- You will have a single drain in place that will run vertically down the center of your forehead. The drain is almost always removed on the first day after the surgery.
- After the drain has been removed you may wash your hair with a gentle shampoo. Lather your hair gently using the palms of your hands and rinse thoroughly until the soap is out. You will not be able to remove all of the crusts until the sutures are all out.
- The scalp sutures will be removed around 10 days following the operation.
- Exercise and strenuous activities should be avoided for 3 weeks; keep your heart rate below 100 beats per minute during that time and do not lift more than 10 pounds. Slowly increase your activities after 2 weeks so that full activities can be resumed at 3 weeks.GENERAL INSTRUCTIONS:
- Tearing and swelling of your eyes will often occur after brow surgery. This will cease as the swelling subsides.
- You may have a dull-type headache for several days after surgery. This is normal. Tightness of the eyelids is a normalfeeling after the surgery. This may make it hard to close the eyelids completely. This will relax with time.
- Contacts may be worn when the eyes start feeling normal and the majority of the swelling has subsided. This is usually around 4-5 days.
- Your forehead will feel tight and there will be a feeling of numbness for several months after the surgery. This will gradually disappear and the feeling will return in about 6 months.
- All incisions will be extremely sensitive during the healing phase. Direct sun contact is to be avoided and use a sunscreen that has UVA and UVB protection for at least 6 months.
- Please take all medications carefully and as directed.
- If you have nausea, vomiting, rash, shortness of breath, or diarrhea after taking your medications please call the office.
- If you develop a fever (oral temperature greater than 101°), redness, or increased pain or swelling at the surgical incisions, please call the office immediately.
- Occasionally, you may have some temporary hair loss in the area of the incision. A majority of time this is temporary and due to the trauma of surgery to the hair follicles-it will resolve in 4-6 months.
IF YOU HAVE ANY QUESTIONS, PLEASE CALL DR SUNDINE
During the hours of 8:30 AM-5:00 PM, please call the office at 949-706-3100. If you need immediate care, please call Dr. Sundine anytime on his cell phone (949-677-5845). There is no such thing as a minor question. I would rather you call me than wonder and not do the right thing, so please call my office or e-mail me any time.
Dr. Sundine’s Office: 949-706-3100
Dr. Sundine’s Cell Phone: 949-677-5845 Dr. Sundine’s e-mail: [email protected]