Brow Lift (endoscopic and open), Foreheadplasty
Indications: For brow lift center around correcting three problems.
- Lateral fullness of the upper eyelid and lower brow; common complaint from patients: looking tired. It's caused by gravitational descent of the forehead and brow skin over the orbital bony rim.
- Frown lines are caused by contraction of the corrugator muscles between the eyebrows over the bridge or root of the nose.
- Transverse forehead wrinkles are caused by muscle activity in raising or lowering the eyebrows themselves
Elevation of the lateral forehead [brow lift] will diminish crow's feet but will not eliminate them; the cause of crow's feet is squinting and wrinkling of the skin which the brow lift itself will not address.
The usual age range for brow lift candidates starts in the early-to-mid-40s; however subtle endoscopic techniques have been performed on patients in their late 30's .
Goals: Subtly elevating the brow
The goal on any face lifting procedure is to avoid an "operated" look.
The endoscopic approach can be done by itself or in conjunction with face lifting procedures. Multiple small incisions are made on the scalp and the muscles are removed (partially by forceps) when being viewed by the endoscope. This minimizes the incision and maximizes the preservation of sensation... but a loss of sensation from the brow lift is still possible when utilizing the endoscopic brow lift procedure. The brow suspension is carried out by securing the deep fascia layer (that layer that surrounds the muscle) and is secured typically to a small resorbable bone anchor device secured in the skull above the lateral eyebrow behind the scalp. This achieves a nice result in young patients who need just subtle elevation and have very little vertical/horizontal forehead lines.
The open approach typically extends the face-lift incisions to connect over the scalp. This fact--in and of itself--causes concern for some women, since it frequently results in a more predictable numbness that can last for approximately one year. This small strip of numbness is posterior (or behind) the incision, covering an area approximately 1-2" wide. This is the one disadvantage in the open brow technique. A predictable and consistent resolution in the forehead and frown lines can be assured.
Complications:
Numbness, Itching & Hair loss. Damage to the frontal branch of facial nerve can also occur.
Recovery:
Pain - Pain is typically not a significant problem in brow lifts. While there's some discomfort and tightness from ear to ear across the top of their head and across the brow, it's usually not a significant problem in brow lifts.
Drains - Drains are usually not needed in the brow area when doing a brow lift or even when used in combination with brow and face-lift.
Swelling - Maximum swelling occurs 48-72 hours post-surgery and begins to subside on the fourth or fifth post-operative day.
Bruising - Interestingly bruising on a brow lift appears in the most dependent areas. As a result, any bleeding usually collects below the eyelids and bruises the lower lids...even if the lower lids are not operated upon. Bruising's usually maximized on the third to fifth day and resolves over 2-3 weeks.
Driving - You can resume driving when you can drive to the level you were able to pre-operatively...and this is your call. You've got to be able to brake and respond quickly, as well as quickly and easily turn to eliminate your blind spot. When these conditions are met you may resume driving...typically the second or third week post-surgery.
Social return - Most patients feel very comfortable in returning to work (physically, anyway) a few days after an isolated brow lift. But socially is a different matter...and you might have to keep your dance card clear for 2-3 weeks.
The average patient can return to work within 10 days, with the help of a little make-up. There may be some and some (mild) residual bruising. If bruising's minimal, the return to work can be even earlier.
Numbness - Sensory nerves run close to the muscular layer and within the muscular layer that's eliminated during a brow lift. As a result, some partial numbness may be present for several weeks post-surgery. Total numbness behind the incision in an open brow lift--whether in the hairline or a standard incision is done--will usually be present for 9-12 months post-surgery...slightly longer in rare instances.
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