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Endoscopic Brow Lift (Forehead Lift)
San Francisco - Oakland - Santa Rosa
Endoscopic Browlift The forehead lift or “browlift” is a procedure that restores a more youthful, refreshed look to the area above the eyes. This procedure corrects drooping brows and improves the horizontal lines and furrows that can make a person appear angry, sad or tired.
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In recent years, the surgical approach to the brow has been advanced with the use of the endoscope. The endoscope is a specially designed instrument with a camera that passes through very small 1 inch incision which allows the endoscope image to be shown on a TV screen. The advantage of endoscopy is the non-invasive nature of the technique. We are now able to achieve equal results with the endoscopic techniques that we were able to achieve with the “open coronal” approach. In the coronal approach, an incision is hidden just behind the hairline and is made from ear to ear. With this approach, the problems have been scaring, hair loss, wider scars, and the cutting of nerves that feed the top of the head. The endoscopic approach has been found to avoid these problems. In some cases when the forehead is high, one may need to use an open approach or the coronal approach to avoid elevating the forehead further. In both cases, however, this approach can be replaced by the endoscopic browlift, which is less traumatic and entails a shorter recovery.
Indications A forehead lift is most commonly performed in the mid-forty to mid-sixty age range. Many people first notice a tired appearance in the region around their eyes as they approach their early forties. Others may notice the development of furrows or frown lines due to stress or muscular activity. This may give the appearance of sadness, depression, unhappiness, or even anger. With the passage of time and under the influence of gravity, the eyebrows descend to a slightly lower position over the eyes. This “hooding” of the tissue around the eyes contributes to the tired appearance. In some men and women the eyebrows are a different height and with this technique, one can achieve a more symmetrical brow level.
Before Surgery
At your first consultation, Dr. Delgado will ask you to discuss your concerns
about your appearance. At this time he will computer image you through
digital photography, discuss your appearance, and have you point out concerns
that you may have. Through this technique, he can modify your appearance
to help determine if a surgical procedure is best for you. If you are
a good candidate, Dr. Delgado will explain the best procedures that will
achieve your goals.
Dr. Delgado will give a precise preoperative instruction pamphlet that
will explain your medications and any preparation that you need to make
at your home. This preoperative pamphlet will also give a concise list
of all aspirin and aspirin containing compounds, including anti-inflammatory
products that must be stopped two week before and two weeks after surgery.
Tylenol may be taken during this time. You will also be given a list of
vitamins and homeopathic drugs to take prior to and after surgery.
Anesthesia The vast majority of endoscopic browlifts area done under general anesthesia. However, in some cases, one may use local anesthesia and an IV sedation. Dr. Delgado and the anesthesiologist will assist in making the best decision for you.
Operative Procedure The endoscopic browlift is generally performed in an out-patient facility. Often times it is combined with a face-lift or an eyelid lift.
Before anesthesia is given, the patient is marked for the incisions and direction of the upper pull. Five incisions are made behind the hairline, approximately one-half inch in length. The hair is not shaved but only parted. The endoscope (a lighted camera) is placed within the incisions and specialized instruments are used to make dissection. A TV monitor is used to observe the dissecting planes. The brow is released from around the eyebrows and the muscles are divided around the frown lines, without compromising the expression. The eyebrows are then pulled up and fixated into position. The incisions are closed with small sutures and a compression dressing is then placed.
If the more conventional coronal browlift is performed, then the incision goes from ear to ear. The only advantage of this technique is that it doesn’t raise the forehead, but the disadvantage is the longer scar.
Post Operative Period During the first few hours after surgery will be spent in the recovery room. When you are completely alert, you will be able to go home with someone to assist you. We advise icing or cold packs around the eyes for forty-eight hours to reduce the swelling and to sleep with the back and head elevated for approximately five to seven days. Some patients will spend the night in the after care facility, especially if a face-lift procedure is performed. The following morning, the headband can be removed. You can shower, wash your hair with soap and water, and reapply the band. The sutures are removed in approximately seven to ten days.
There is minimal pain with an endoscopic browlift. The patients describe swelling and a “woodiness” to the forehead area, and the discomfort is minimal. Pain medication is prescribed, but only used for a day or two. Sleeping with the head and back elevated is critically important in reducing the amount of swelling.
The swelling and bruising usually subsides completely within ten to fourteen days. Most patients return to work and social activities after seven to ten days and strenuous exercise can be started in the four to six week range.
Risks and Complications Complications are rare and usually minor when a forehead lift is performed by a qualified plastic surgeon, yet the possibilities or complications must be considered. Like all surgeries, the risks of bleeding, infection, scaring, or an anesthetic problem is possible. The risks from complications, however, from the endoscopic browlift are less than would be with the standard coronal browlift. For example, there is less scaring, potential hair loss, and no significant degree of numbness. In rare cases, the nerve that controls the eyebrow movement may be injured on one or both sides, resulting in a loss of inability to raise the eyebrow or wrinkle the forehead. If this occurs, it is usually temporary.
Results The results of the endoscopic brow surgery are a more rested and revitalized upper portion of the face. This technique greatly reverses the angry, unhappy, sad, or tired appearance. The improvement can be expected to last many years. However, you will continue to age and gravity will still occur, but the area will always look more rejuvenated. The browlift techniques can be done again in time if necessary.