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 results of a properly performed, and surgically sound, operation will typically last up to a decade. The surgery obviously cannot halt the aging process, and to a certain degree just give the illusion of setting back the hands of time. Aging then takes over once again, but not to the same degree, or at the same rate. This is because some of the skin was removed, and some of the underlying tissue repositioned, at times more superior than in youth. This allows for less tissue to be acted upon by gravity. Beware of miracle cure operations that promise lasting results with less surgery. Such procedures may be more profitable to the “surgeon” performing them, more surgeries may be done because they do not take as long, but the patient will generally be back to square one within six months, plus a few “minimally invasive” incisions, and minus some had-earned capital.

“Brow Lift” is just what it says. It is also referred to as a browpexy. The brow lift addresses the sagging of the eyebrows, and underlying forehead and frown muscles. Signs of aging in the upper third of the face include a receding hairline, transverse forehead rhytids (the spaghetti looking wrinkles that run across the forehead), glabellar rhytids and furrowing (lines between the brows caused by frowning), “bunny lines” (over the junction of the nose with the forehead, brow ptosis (droopy eyebrows), excessive upper lid skin (dermatochalasis), and periorbital rhytids (“crow’s feet”). The brow lift is used to lift sagging eyebrows, remove some of the muscle causing glabellar furrowing and forehead creases, and possibly tighten the skin to the outside of the eyes to take care of any excess contributing to crow’s feet. If deep wrinkles are present, the brow lift may be combined with carbon dioxide (CO2), or erbium laser resurfacing. Phenol or TCA peels may be added as well.

• Customary, Standard, or Traditional Brow Lift or Browpexy
• Endoscopic Brow Lift
• Endotine Brow Lift
• The Trans-blepharoplasty or TransBleph Brow Lift using the ENDOTINE® Device
• Lateral Brow Lift or Temporal Lift
• Mitek Tac-it® Endoscopic Brow Lift

Because every surgeon has a preference for a particular procedure, every surgeon will have a different idea as to what constitutes the traditional brow lift. The most common interpretation of the “standard” brow lift is the open approach involving a coronal incision, whereby the cut is made either behind or along the forehead hairline. The forehead is undermined to the level of the eyebrows, either on top of the bone (subperiosteal), or on top of the bone covering (subgaleal). Frown muscles (corrugators, procerus, and depressors) are resected (removed). In some cases, sections of the frontalis (the eyebrow raising muscle, and the same one that causes the cross-forehead creases) are also removed. The brows are fixed in a symmetric configuration that is aesthetically pleasing, taking into account patient sex, and preoperative preference. A sliver of skin is removed at the edge of the incision, which serves to tighten skin laxity.

The endoscopic brow-lift is typically performed in younger patients, in whom the problems include brow ptosis or drooping, with or without excess upper eyelid skin, as well as crow’s feet, but without significant forehead excess skin. Because minimal skin excision is needed, the brow lift is performed through three small incisions behind the hairline. There is a multitude of devices available for fixation of the brows. Dr. Gerzenshtein prefers the Endotine® Forehead fixation device. The two outside (lateral) incisions serve as points of small triangular skin excisions. In addition, the lateral brow-lift may be added to the endoscopic approach to correct any skin excess, especially when the brow lift is combined with the lower blepharoplasty, with or without the midface lift procedure.