1) How do I know if I need an upper eyelid lift or a browlift?
It depends on the position of the brow. During the initial consultation to evaluate the upper eyelids, the surgeon uses his hands to raise the patient's forehead skin to an appropriate level. When the forehead skin is raised, if most of the upper eye lid skin disappears, a patient would most likely benefit from a forehead lift. If raising the forehead skin has little or no effect on the upper eyelid skin, an upper eyelid lift (blepharoplasty - pronounced bluff ar oh plasty) may be all that is in order. If improvement is noted when the brow is lifted and excess skin remains on the eyelids, a combination of browlift and upper eyelid blepharoplasty may be recommended.
2) If I have a browlift, will I end up with a "surprised" look?
First things first - a browlift does not automatically mean that the brow will be elevated. A browlift can be performed to lower the brow, to raise the brow or retain the same brow position.
Second, it's not uncommon for patients to see themselves with a "surprised" look for up to three weeks following browlift. This surprised look can result from temporary swelling. After three weeks a patient may continue to see this look as a very noticeable change, yet others are completely unaware of it. Browlifts can raise OR LOWER the brow. An experienced cosmetic surgeon knows the essential combination of the correct position of the brow and the result that the patient is trying to achieve.
3) What does "endoscopic" browlift mean?
Endoscopic browlift means that your surgeon is using a telescope about the diametral of a pencil eraser to perform the surgery. When the telescope is inserted under the skin, the area is displayed on a television screen.
Endoscopic browlifts have several advantages. First, endoscopic browlifts allow the surgeon to address the brow, upper eyelids AND a portion of the lower eyelids. One of the most common requests - eliminating the "angry look" or frown lines (created by the corrugator muscles) between the eyes - can be addressed with the endoscopic approach. Along with the advantage of smaller incisions, browlifts performed endoscopically have less chance of infection, fewer sensation changes (less numbness and itching), less wound care and fewer side effects following surgery. Also, with endoscopic browlifts there is no compromise to the hair.
Not all surgeons are experienced in endoscopic browlifts. When evaluating a surgeon, it's important to ask not just how many browlifts he or she has done - but, how many endoscopic browlifts have they performed.
4) How long does a browlift last?
As with facelifts, the longevity of the benefits of a browlift are dependent on several factors. For patients who do not smoke, do not abuse the sun, are in good general health and have good genetics, a browlift can last five to ten years. For patients who elect to abuse their skin and body, a browlift will only last up to five years.
5) What's the difference between endoscopic browlift and midfacelift?
Endoscopic browlifts have the ability to raise or lower the brow and address the upper and part of the lower eyelids, stopping at the bony rim (called the zygoma - Ci go ma) below the eyes. If a midfacelift is also performed, the surgeon is able to provide middle face rejuvenation -including any remaining portion under the eyes and the area of the face level with the nose down to the teeth. With the addition of a midfacelift, the cheek is elevated, it pads the bony rim of the lower eyelid thus necessitating less fat removal. This improves our ability to treat lower eyelid "bags" and rejuvenate the bony orbital rim by precisely treating the droopiness and bagginess about the eyes in the manner that it ages. See Before and After Photo to compare area below eyes.
6) Will I still look like "me" after surgery?
Many of our patients report that, upon return to work and routine daily activities, friends and acquaintances make the following remarks: "Gee you look great. Did you change your hairstyle?" or "Have you been on vacation?" Retaining your uniqueness is the sign of a successful procedure. Although the change may be significant to you, it's not uncommon that friends and family don't really notice the specific changes.
7) Yes, but I want to dramatically change the appearance of my brow. Can I do that?
This is an excellent question because it leads to evaluating realistic expectations. This question can only be answered on an individual basis. A sign of a good board certified facial plastic surgeon is one who can tell the difference between realistic and unrealistic expectations and one who will be truthful about meeting each patient's desires.
8) Will a browlift get rid of these deep frown lines between my eyes?
Yes. As we stated above, frown lines are one of the most common reasons that patients seek browlifts. Patients tell us about hearing comments such as "she looks angry" when, in fact, they are very good natured. Frown lines are more often the effect of the corrugator muscles and premature aging. Some of the deepest lines may not completely resolve, however they will be significantly improved. Adding a finishing touch with filler or resurfacing options provides optimal results.
9) Will a browlift get rid of the horizontal wrinkles in my forehead?
As we age, our skin looses its elasticity. A browlift is most often performed to relocate the brow and restore it to a more youthful position. A browlift will not remove fine lines and wrinkles in the skin as a result of aging, sun, tobacco abuse, etc. Frequently patients elect to have skin resurfacing (such as CO2 laser) at the time of the browlift to address both concerns. Many patients who are not ready for surgery will visit the Lindsay House Medical Spa to consider Botox, Collagen, Microdermabrasion or several other conservative procedures - many of which can be performed on the lunch hour.
10) How much pain will I have?
Most patients who have browlift surgery say how surprised they are that the pain is less than they anticipated. Understandably, after any surgical procedure, some discomfort can be expected. All patients are provided with prescriptions for pain medication. Patients sometimes use the prescription medication four to five days after surgery and then switch to Extra Strength Tylenol. Patients undergoing a midfacelift will have some pain on chewing for about 48 hours. It is uncommon for patients to report unmanageable pain after surgery.
11) If I have a browlift will it also lift my face?
As we described above, browlifts have the additional benefit of addressing the area below the eyes. When combined with a midfacelift suspension, which can be performed through the same incisions, the procedure does lift some sagging in the face. A midfacelift will not, however, address one of the most common concerns of cosmetic patients which is the "turkey wattle" (that thing that hangs down from a turkey's neck) to tighten the neckline
12) Where are the incisions for endoscopic browlift?
The beauty of the browlift is that it is done endoscopically. The incisions are approximately one half to one inch long, all hidden in above the hairline. Because of incision placement, browlift incisions heal very well and most patients and family members will not notice them after a few weeks.
13) What if I have a history of bad scars?
If you have pierced ears, the way you healed there is a good indication of how you will heal from facial plastic surgery. Scars on the rest of the body typically are not an indication for how patients heal following facial plastic surgery. At the time of your consultation, it's important to show your physician any previous scars (keloid scars) that are of concern to you so he can give you a realistic assessment of your healing potential following facial plastic surgery.
14) Will I be awake during surgery?
Patients are asleep using IV sedation (medicine administered through an IV) and a local anesthetic (numbing medication administered in the operating room). Patients do not hear or feel anything and are comfortable during the operation. Patients wake up very soon after the surgery is completed. Intravenous sedation is a type of anesthesia; therefore all patients must have a responsible adult to stay with them through the night following surgery. Patients may not drive for seven days following their procedure and this time may be longer, depending on the procedure.
15) Do I go home after surgery?
Most browlifts are done on an outpatient basis. Because you will go home after receiving sedation, you will need to make arrangements for a responsible adult to drive you home, to stay with you overnight and to drive you to our office for your first postoperative appointment. Patients having surgery must stay in the immediate Rochester area overnight within 30 minutes of our East Avenue facility.
16) How long will bruising and swelling last?
Postoperative bruising and swelling begins to resolve at the end of the first week. Full resolution of bruising or swelling may take two to three weeks. However, you may camouflage bruises fairly easily at seven to ten days with concealer stick.
17) How long should I stay in Rochester following surgery?
Most patients stay in Rochester about seven to ten days following surgery. After that it's ok to fly or travel long distances.
18) I'm from out of town. Where can I stay overnight in Rochester?
Accommodations are comfortable and convenient for Lindsay House clients. The Strathallan, located "just down the street" provides upscale, affordable accommodations for Lindsay House visitors. For added convenience following ambulatory surgery, some patients elect to stay in our Carriage House, located adjacent to the Lindsay House. For guests without the benefit of family or friends in the Rochester area, our staff will be happy to assist you with arrangements for a smooth, restful experience following your procedures.
19) When can I go back to work?
Restrictions from work are generally two weeks for browlift surgery. Because initial surgery swelling may still be present, patients who are more concerned with privacy about the procedure take three weeks off to be safe.
20) When can I "work out?"
Aerobic activities should be avoided for three weeks following surgery. Any activity that potentially increases blood pressure will increase the amount of time it takes for postoperative swelling to resolve.
21) I want to know details about the procedure.
Glad you asked! the preoperative and postoperative instructions are listed below.
BROWLIFT PREOPERATIVE INSTRUCTIONS
1) What do I do to prepare for surgery?
Although the preparation for surgery is pretty simple, it is an essential element in a successful outcome. To prepare for surgery, a preoperative appointment will be scheduled with one of our experienced nurses.
2) What happens at the preoperative appointment?
Many things! To name a few, you will meet with our nurses who review your health history, answer your questions, instruct you on how to prepare for surgery, provide prescriptions for use after surgery and tell you what to expect. Most of the instructions are listed here below. This list of questions, however, will not take the place of a preoperative visit, which is essential in determining a patient's understanding and readiness for surgery. We will be sure you are signing an informed consent.
3) What does informed consent mean?
Informed consent means you have an excellent understanding about the benefits of surgery as well as any risks, and all the preoperative and postoperative information. You are making an "informed" decision as to whether surgery is right for you.
4) What are the benefits and risks of a browlift?
As part of your initial consultation, your physician will review your expectations for surgery. At that time, he can provide a realistic picture of what surgery can and cannot accomplish. Depending on which procedures you are interested in, we will provide you with a list of any risks reported in the medical literature associated with any procedures you are considering. Although risks from cosmetic surgery are uncommon, every patient should be fully informed of any risk associated with surgery.
5) What are some of the other things to do to prepare for surgery?
We review your health history and any daily medications you may be taking.
6) What about my daily medications before surgery?
You will have a preoperative appointment well in advance of your surgery when our experienced staff will review all mediations with you. If you are on "blood thinners," you will be asked to stop them approximately one week prior to surgery. See below about vitamins and supplements before surgery.
7) I take vitamins and supplements. Do I need to stop them before surgery?
Most vitamins and supplements have few side effects. However, there are some that can affect bleeding during surgery such as Vitamin E, ginkgo-biloba, fish oil and others. We will provide you with a list of medications and supplements to avoid before surgery.
8) Do I need any special prescriptions before surgery?
Most patients do not need any special prescriptions before surgery. Please let us know of any special medical concerns you may have. Because tobacco abuse impedes wound healing, you will be asked to stop for two weeks before surgery and two weeks following surgery. Our nurses will be happy to discuss over-the-counter aids to help you with this. In the postoperative instructions that follow, we will discuss all medications needed after surgery.
9) Why will I be asked not to eat or drink anything after midnight?
The best way to prevent after effects from anesthesia will be to avoid food or drink from midnight the night before surgery. For patients with special concerns, such as a patient with diabetes, our nurses will be happy to address arrangements with you ahead of time.
10) What happens when I check in for surgery?
Our nurses will help you get ready for surgery. We check your blood pressure, listen to your heart and lungs, start an IV and such. Please let them know of any special needs you may have. Also, be assured that you have plenty of time for any last minute questions with your doctor.
11) I'm concerned about privacy.
During a recent independent study, privacy was found to be one of the advantages that attracted people most to Lindsay House. Because all consultations, office visits, surgical and nonsurgical experiences take place at the same address, the check-in process is completely confidential.
12) Does someone have to stay at the Lindsay House while I have my surgery?
No one needs to stay at the Lindsay House during your surgery. However, you must have someone available by telephone at all times during your surgery.
13) What other instructions are there?
Glad you asked! See the postoperative instructions below.
BROWLIFT POSTOPERATIVE INSTRUCTIONS
1) What do I look like when I wake up from surgery?
Following the procedure, you will have a soft head wrap around your head and under your chin. This helps minimize swelling. Initially, some patients report a shiny forehead or a "surprised" look because surgical swelling has raised the eyebrows. As this swelling subsides, the surprised look disappears. You may have some bruising, however, this is typically more pronounced 24-48 hours after the procedure if eyelid surgery has also been performed.
2) Can I do anything to prevent bruising?
Most patents will have a little bruising. We can minimize bruising by using Arnica before and after the procedure. Arnica is a natural "herb" that helps prevent bruising.
3) What does it feel like when I wake up from surgery?
Most patients report only mild to moderate discomfort, which may be associated with some numbness, itching, tightness or a pulling sensation. These postoperative symptoms subside with time. We will make sure you are not nauseated or queasy. Our nurses will be right there with you as you wake up from surgery to give you special attention.
Patients initially experience numbness for the first six to twelve months following surgery. About two months after surgery, it is common to have itching or "pins and needles" as the sensation returns. This itching is significantly less with an endoscopic browlift than a traditional browlift. This is actually an important point because patients who scratch or "itch" their hairline can thin the hair.
4) Tell me more about the incisions.
The head wrap will be removed in the office the morning following surgery. After the head wrap dressing removed, you will notice little clips in your hair. An elastic (ace) bandage will be gently applied to minimize swelling. We ask that you keep the elastic wrap in place at all times for a few days following surgery. After that we will ask you to wear it at bedtime only for about a week. You will be asked to return to the office about seven days from the surgery date for removal of clips. Because most patients tell us their forehead is temporarily numb following browlift, it is uncommon for patients to complain of significant pain with clip removal.
5) When can I shower?
As long as you keep your head dry, you may bathe at any time following the procedure. Approximately four days following browlift, one may shower and gently wash the hair. Also we request that you shower and wash your hair twice before your second postoperative visit: both the evening before and the morning of clip removal (approximately postoperative day seven).
6) Will I need any special prescriptions following surgery?
Yes. Postoperative prescriptions are provided well in advance of surgery day so you arrive home completely prepared. Postoperative prescriptions and over-the-counter medications for browlift patients include the following: