Skin resurfacing, whether laser (CO2 or erbium laser) or chemical (TCA or phenol, or blue peel), brow lifting (brow-pexy) and face lifting (rhytidectomy surgery), are not mutually exclusive. In fact, resurfacing, brow-lifting, and rhytidectomy are complimentary. Skin resurfacing addresses fine wrinkles, pigment changes, and irregularities associated with aging. Facelifting addresses creases, skin and fat excess, as may be found in smile lines, marionette lines, jowling, and “turkey neck.” Brow Lifting addresses forehead creases, droopy brows, and furrows. To get the best possible result from facial rejuvenation, it is often necessary to perform rhytidectomy, brow lift, forehead smoothing surgery, and some type of laser or chemical resurfacing either at the same time or after recovery from the face lift.
Endoscopic Brow 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.
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 brow lift. 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. Most numb places will regain sensation over several months, in the case of the open or coronal brow lift 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. 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 which 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. Tell-tale signs of surgery will resolve within 1-2 months. The final result will be obtained once all of the swelling has resolved, typically around six months.
Uneven swelling and bruising may be the result of bleeding, which would require a prompt decompression. Uneven swelling later in the postoperative course may signify an infection, which is treated via antibiotics and possibly drainage. Cloudy drainage, fever, or spreading redness all point to an infection as well.
When prescribed, antibiotics are extremely important to take as directed for proper blood levels and effect. Antibiotics may cause gastrointestinal symptoms, loose bowel movements, or yeast infections. Prompt notification is the key. Anti-emetic (nausea), analgesic (pain), a sleeping aid, and a stool softener should also be prescribed, and taken as directed. If you are sensitive to narcotic medication, start off slowly, with ½ or ¼ dose and work up (this class of pain medication may not only make you disoriented, lethargic and nauseated, but also constipated, and can cause you to have a difficult time urinating).
You should never mix Tylenol™ with certain combination narcotics that already contain acetaminophen, as this may cause damage to your liver. If you do not want to take the prescribed pain medication for any reason, simply substitute it with Tylenol™. Any of the prescribed medications may cause an allergic reaction. If you notice swelling, redness, raised wheals over any portion of your skin notify the office. If you have trouble talking, breathing, have tongue and mouth swelling; consider it a medical emergency and cal 911 without delay. Finally, do not drink alcohol while using the prescribed medicines for at least two weeks until after surgery. This is because there are dangerous interactions between alcohol and pain, nausea, and insomnia medication. Alcohol may render the antibiotic useless, worsen fluid exacerbation, and result in a dehisced incision from bumps or falls sustained while inebriated.
It is common in this day and age to use dilute local anesthetic before making an incision. This type of pre-emptive anesthesia reduces post-brow lift discomfort immensely. In general it takes several hours for the effects of the local to wear off. Soreness improves over several days following face lift surgery, and is very well controlled with oral pain medication.