Brow Lift

Every physician, plastic surgeons included, is different, and has a different approach to the patient. Most plastic face lift surgery doctors, however, are very compulsive, and have a set routine. Established pre and post-operative routines set up a significant degree of certainty in surgical outcomes, and ensure appropriate treatment when problems do arise. Adequate patient instruction prepares the patient for face lift surgery in a number of ways. Patients know what to expect, so that anxiety is greatly reduced. Patients are educated in fitting versus harmful peri-operative activities, helping to minimize a poor outcome based on an inappropriate patient action. Finally patients become familiar with the correct course of action in the event of an otherwise unexpected event.
Dr. Gerzenshtein’s typical routine includes a thorough physical examination with particular attention to areas of concern. The patient is asked for the most important aspect of the concern, the full smile lines, the jowls, the sagging neck, etc. A global assessment is then formulated and presented to the patient. Dr. Gerzenshtein seeks to then marry his opinions with the patient’s dislikes to devise a mutually agreeable plan. A pre-operative sheet is then given to all prospective plastic surgical candidates. This is because in most circumstances, not satisfying the conditions presented in the pre-operative plastic face lift surgery guidelines, such as discontinuing aspirin for at least two weeks prior to cosmetic face lift surgery, will lead to a delay of procedure.

Should the prospective aesthetic face lift surgery patient decide to have cosmetic face lift surgery, a pre-operative visit is scheduled. This is where the details of the particular aesthetic facial face lift surgery treatment are reviewed. The visit includes either a complete physical examination, or review of a physical performed by the patient’s primary care physician, all to determine fitness for face lift plastic face lift surgery. Appropriate laboratory evaluations are ordered, or reviewed, as are any other pertinent studies. A complete discussion of all risks and complications associated with rhytidectomy or face lift surgery are reviewed, pre-operative photographs are obtained. Finally, thorough postoperative instructions are given, along with prescriptions for after face lift surgery. In this manner, a patient is thoroughly familiar with the particulars of the face lift surgery, expected outcomes, and postoperative care after a face lift.

The ENDOTINE® Endoscopic Forehead Lift Procedure is essentially the endoscopic browpexy that uses the ENDOTINE® Forehead fixation device to achieve stable fixation of the forehead tissues. Three incisions are made behind the hairline, one in the center, the other two behind the highest portion of the non-hair bearing scalp in the front. Dissection is carried out under endoscopic guidance to achieve release of the forehead skin and underlying soft tissues. Furrow-causing muscles are removed, and cross crease muscles are weakened. Adequate release is assured by elevating the skin and witnessing re-positioning of the eyebrows in a symmetric fashion. Two symmetric drill holes are made in the outer portion of the skull. This is done with a drill bit that is protected from entering too deep into the bone. The fixation devices are deployed. They look like plastic hang-hooks. The skin is re-draped over the hooks in the desired position. Extra skin is removed from the two outside incisions, and the incisions are closed.

There may be many reasons why undergoing a brow-pexy or brow lift would be dangerous or ill-advised. The most commonly reversible causes include medications that interfere with normal blood clotting mechanisms, have interactions with anesthetic agents, or impair healing. Such contraindications are usually not problematic, in that most patients can temporarily suspend the use of these substances prior to surgery. More serious reasons not to undergo a brow lift include health problems such as coronary artery disease, pulmonary disease, etc. Such disorders significantly increase the chances for adverse outcomes, especially with the use of general anesthesia. In addition certain connective tissue disorders may pose relative and some even absolute contraindications for rhytidectomy. Ehlers-Danlos Syndrome aka Cutis Hyperelastica, Cutis Laxa, Pseudoxanthoma Elasticum, Progeria aka Hutchinson-Gilford Syndrome, Adu1t Progeria aka Werner’s Syndrome, Meretoja Syndrome, Idiopathic Skin Laxity.

If you need to take something for relief of minor pain, you may take Tylenol.

On waking from anesthesia, you will find yourself in the recovery room with dressings, and ice or gel pack in place. Your vision may be blurry owing to protective ointment applied to your eyes during surgery. You will be able to depart once sufficiently recovered from anesthesia, and lucid. A friend or family member will drive you home and stay with you for the next 2 days to help you with activities of daily living. Initially, you will feel tired and run down. This will be at its worst in the first several days after surgery. The lethargy may be attributed to general anesthesia and will improve substantially over the first week after a blepharoplasty. Discharge from your incisions should be minimal over the 1st 2 days after surgery, though bleeding may occur with excessive activity, and at least some spotting over the dressing is normal. The dressing present after surgery will be removed, along with a special garment, during the first post-operative visit. Drains, if present, will likely be discontinued at the same time. If dilute local solution was used (superwet or tumescent technique) pain and discomfort will be mild initially, and will increase and peak within two days. The pain will then subside over the course of one to two weeks. Use of prescription pain medication will help significantly.

Nausea and vomiting in the postoperative period is not uncommon and has to do with the type of anesthesia used and overall patient sensitivity to the various medications. It generally resolves within 1 to two days after surgery. Increasing fluid intake (provided you have no history of heart or fluid trouble), especially via one of the “ade” (Gatorade, PowerAde, etc.) solutions available for sports use, combined with anti-emetic medication should minimize this problem.

Use of opiate pain medication, combined with inactivity, and dehydration may lead to constipation. Increasing fluid intake will help this as well, especially in combination with walking, and use of a stool softener.

Swelling and bruising peak within three days of surgery and gradually subside over the following week, but may persist for up to four weeks. The two sides rarely bruise to the same degree, and a mild difference in swelling is normal, however, if swelling is notably different you will need to come in for evaluation immediately. Your appearance early on in the course of recovery may be distorted by a significant amount of swelling, giving you a bloated, puffy, pale appearance with blotchy bruising. Do not be disturbed, this will pass, and you will look and feel much better within several weeks.

Apart from swelling and bruising, most patients will experience tightness and numbness over the forehead if a browlift was performed with the blepharoplasty. Most numb places will regain sensation over several months, in the case of the open or coronal browlift approach; this may take up to six months. Expect improvement in all of your symptoms, worsening over the course of recovery is not normal and needs to be addressed via a prompt phone call. If a browlift was performed, hair may be lost around the incision 1 month after the surgery. It will usually return within 4 months after the initial loss. Healing incisions will adopt a pinkish hue that should gradually fade over the next six months to a year.

Some patients react to absorbable (inside) suture, small pustules or whiteheads along the incision may signal this. The suture may be removed in the office if the problem becomes bothersome.

Facial camouflage make-up may be applied two weeks after surgery to conceal bruising, and healing incisions. Telltale signs of blepharoplasty surgery will resolve within 1-2 months. The final result will be obtained once all of the swelling has resolved, typically around six months.

“Beauty is in the eye of the beholder.” What is considered attractive in some social or ethnic circles is frowned upon in others. For this reason, ethnic, including social, and/or religious considerations determine a patient’s opinion of what is desirable. Only this consideration may alter the choice of one procedure over another. Assuming the outcome is predefined, that is the goals of face lift surgery are clearly delineated, outcomes should be uniform with few exceptions. Genetic factors and complexion may predispose a patient to loss of pigmentation, or an increase in the same. This is generally observed with resurfacing modalities, like laser CO2, phenol, or TCA peels, rather than face lifting itself. Keloid formation would be an unusual, but cosmetically devastating complication, and is more prevalent in the darker skin patient.

Generally, any drains (present after the procedure) are discontinued the day after face lift surgery, if drainage is excessive, the drains stay in until drainage is deemed minimal. Should the tube opening start draining, dry it, then place 4X4 gauze around the skin where the drain comes out, tape the dressing. Please strip the tube every time you empty the drain, and record the drainage.