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FOREHEAD AND EYEBROW LIFTING
(Browplasty)
As men and women age, their eyebrows may droop, creating a somewhat sad or oppressed look. Such sagging may coexist or be independent of other signs of facial aging. Correction of the forehead and brow may be done concurrently with any of the other surgical procedures described in this chapter.
There are alternative surgical solutions with different approaches and techniques. If tissues between the brows (just above the nose) and the eyebrows themselves have sagged to the same level, a forehead lift is indicated. Forehead/brow lifting yields a more natural, brighter appearance by elevating and tightening the eyebrows, forehead skin and muscles. In certain instances, frown lines and forehead creases also mildly improve. Results are best when brows are elevated to a "natural" level. Overdoing this procedure will create a very unsatisfactory "always surprised" look. This result should be avoided, since it cannot easily be corrected.
One route to the forehead and brow can be via a long horizontal incision at the hairline or paralleling it further back, depending on forehead height and scalp hair density. The second route is by "tunneling" under the scalp, usually through three short, hidden incisions. An endoscope (a tubular, lighted, periscope-like device) guides long-shafted microsurgical instruments to the target area to perform the necessary maneuvers. Technically, it is similar to knee and shoulder arthroscopy or colonoscopy.
Some surgeons perform a "temporal lift" that attacks only an outer, lateral (towards the ear) eyebrow droop. That technique is performed through an incision at or behind the temple hairline, above the ear. For some carefully selected patients, the outer, lateral drooping brows can be lifted by a direct approach, at the upper edge of the brows.
The decision regarding which procedure is best for you is made at consultation. With either surgery, healing is generally rapid and uncomplicated, and the patient can resume normal activities within one week.
We conclude that both endoscopic and coronal/pretichial (at the hairline) forehead lifts provide for comparable elevation at 1-year follow-up. Brow elevation in coronal/pretrichial forehead lifts may be temporary.-Steven H. Dayan, MD, "The Forehead Lift: Endoscopic Versus Coronal Approaches," Aesthetic Plastic Surgery, August 2000
Specific Questions to Ask When Considering A Forehead or Brow Lift:
- What is the difference between "endoscopic" forehead brow lift and older techniques? Describe the "older" procedure.
- Why is the newer one better? With the "endoscopic" technique, where are the incisions made?
- My biggest problems are the deep lines between my eyes from frowning. Will forehead or eyebrow lifting help my appearance?
- My brows hang so low that they seem to cause problems with my vision. Does this mean both the brows and eyelids must be lifted?
- Is there a chance the nerves to the forehead can be injured? If so, what will I look like? Can this be repaired?
- Will there be a lot of bruising around the eyes and forehead?
- How soon can I return to work and normal activities?
Eyelid and Forehead/Eyebrow Lift
- Convalescence: The first night can be spent at a hideaway retreat or with professional home attendant. If you prefer to be at home, a precise instruction/direction sheet and "care package" of medications and supplies allows for home care by any responsible adult.
- Stitch removal: Upper eyelid stitches are removed between the fourth and sixth postoperative days. Lower eyelid stitches dissolve and generally do not need removal. Hidden forehead stitches may remain in place for up to ten days.
- Return to work: Most patients are capable of reading, writing and light activity within forty-eight hours of surgery. Normal activities can resume in five to seven days. No strenuous exercise for ten days.
- The first week: Any significant swelling and bruising during the first week can be concealed by wearing sunglasses. Eye make-up can be applied after stitches are removed. Eyes or brows may feel "tight"
- After the first week: Incisions are concealed in normal skin creases, but are slightly visible in the first four weeks following surgery. Each week their visibility is reduced until they are nearly imperceptible about six weeks. Nightly application of a multiple vitamin ointment silicon gel is advised to promote rapid healing.
Combination Of Surgical And Non-Surgical Facial Techniques
Many women over fifty-five, depending upon heredity and lifestyle factors are plagued by both "sagging" tissue and wrinkled skin. The sagging tends to occur earliest at the jawline, upper neck and under the eyes. Wrinkling may be most evident near the eyes, between the eyebrows, and around the lip and mouth areas.
I will be 55 next month and everyone in this one stoplight town is amazed that I even got invited to my first baby shower in 20 years because the waitress who is having the baby assumed I was in my late 30s. When I tell them about the facelift and peel, they are fascinated. That kind of thing is rare in these parts. I have explained that in California, it's an unofficial law that you have to get things ‘done' to stay looking as good as you can for as long as you can.
-April, screenwriter and chili manufacturer, Tennessee
Because wrinkled and age-spotted skin must be addressed by a facial rejuvenation process, and sagging tissue must be corrected surgically, some patients require two different techniques to best enhance their appearance. Often a sequential combination of procedures both surgical and non-surgical is used. The result always exceeds that of any single procedure.
The good news is that each technique is effective and reliable; the bad news is that they cannot always be safely performed at the same session. Depending on which procedures are needed, an appropriate interval may be several weeks to three months.
Usually, but not always, surgery is done first since the chemical or laser process may help further erase the nearly invisible surgical scars. The discussion about the ideal order of procedures and the interval between them must occur on an individual basis, at consultation.