Endoscopic Brow Lift

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.

If you are not a local resident, you should plan to arrive at least a day prior to the procedure to familiarize yourself with your temporary habitat. You will need to remain here, whether at a local hotel, or with a relative or friend for approximately one week after surgery. You will also need to notify the office of your planned residence. If a resurfacing procedure is planned along with face lifting for total facial rejuvenation, you will need to pre-treat for approximately six weeks before surgery. Our aestheticians will help with this. Of course all prohibited medications must be stopped at least 2 weeks prior to surgery. Make sure there is someone who can help you get about for the first several days after surgery as swelling and discomfort may limit your ability to do so. Preparing meals in advance, having someone cook for you, or planning to order out are all things to consider and have arranged prior to surgery. Ice packs should be stocked to last for 48 hours. A less expensive alternative may be frozen vegetable packs.

If you are a nicotine user you must quit nicotine 6 weeks before surgery. That means you must quit smoking tobacco, chewing tobacco, chewing nicotine gum, using the nicotine patches, or any other imaginable method of nicotine delivery. A pre-operative history and physical must be performed by your primary care physician, within four weeks of having surgery. You have, or will be given a list of prohibited medications. Please refer to this list to guide you in substances incompatible with, or not conducive of surgery. The most important of such medications not take for at least 2 WEEKS prior to surgery include drugs which interfere with clotting (‘thin”) your blood such as aspirin, or any non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (advil,motrin,nuprin) or naproxen (aleve, naprosyn), blood thinners (coumadin or lovenox for example), and/or vitamin E. You must check with your primary care physician or cardiologist prior to discontinuing the aforementioned drugs. The prohibited medication list includes any herbal or non-traditional substances or medications, and diet medications. Do not consume any alcohol, or use any illicit drugs for at least two weeks prior to surgery. If you develop a viral illness, cold, upper respiratory tract infection, urinary tract infection, sores, boils, or any other new medical problem before surgery, notify our office as soon as possible. If you are not spending the night in the hospital or recovery suite after your surgery, please make arrangements to have a responsible friend, or relative drive you to the facility, and drive you home after the surgery.

The price for a brow lift varies very widely, and depends on several factors.

1. How competitive is the market?
2. How reputable is the surgeon?
3. Is the rhytidectomy done in the hospital or office?
4. Is the rhytidectomy done under general anesthesia, or sedation?
5. How invasive is the face lift, or how long will it take?

Based on the above the bottom line can range from five thousand to fifty thousand dollars. Why the discrepancy? The more saturated the market is with surgeons who fancy themselves brow lift operators; the more likely they are to try to undersell the competition. Of course, if the surgeon is completely booked, has an impeccable record for outstanding results, and/or is recognized nationally, he or she will operate on the most affluent patients, and the asking price will be substantially higher. Procedures performed in the hospital will run more because of the customary mark-ups, unless your plastic surgeon has worked out a special deal. General anesthesia introduces the anesthesiologists’ fee. Finally, the particular technique matched to the patient’s problem may require less than two hours of operating time, or more than six. This not only affects facility, and anesthesia fee, but most surgeons will charge considerably more for a more involved operation.

Depending on the type of brow lift performed, recovery can last from as little as several days to as long as three to four weeks. Assuming the most invasive form of brow lift was carried out; the sequence would include a possible overnight stay. In either instance, assuming an uncomplicated course, immediate recovery from anesthesia takes from one half to a full hour. Patients go may go to a private suite prior to discharge, or when staying overnight, to an appropriate room. Drains would likely be present, and be removed the following day. Swelling is worst at 48-72 hours, and should gradually subside thereafter. Sleeping with the head elevated on several pillows will do much to aid in drainage and diminish facial puffiness. Pain begins to improve significantly after 3-4 days. Oral pain medication will do a lot to alleviate most of the discomfort. Numbness about the central forehead does not affect the majority of patients, but it is not rare. Numbness behind the hairline incision in the case of open or coronal brow lifting is a drawback to this type of procedure. This is why endoscopic brow lifting is preferred to the coronal approach. If loss of sensation is present, parenthesis may take from six to twelve months to resolve. Bruising is normal, and may change color over days. Uneven swelling and bruising are not normal, and may signal a bleeding problem, early on, and infection later in the course. Both of which are not very common. In any case, notifying Dr. Gerzenshtein as soon as possible is essential to a good outcome. Other findings that may merit the same action are loose sutures, cloudy drainage, fever, or redness. Visible sutures are removed within 5-7 days. Sutures or staples behind the hairline and ears are left in for 10-14 days.

Make-up may be applied after one week. Light exercise may begin 7-10 days after surgery, while more strenuous activity should wait until after one month has passed.

Risks associated with brow lift surgery may be grouped into anesthesia risks, and surgical complications. Anesthesia risks are common to any surgery and are discussed elsewhere. Events such as cardiac complications (heart attacks or myocardial infarctions), allergic or anaphylactic reactions, lung-related adverse effects (pulmonary embolism, pneumonia), kidney, liver, or any other organ system problem would all fall under that category. Complications related to the act of surgery may be grouped into risks involved in undergoing any procedure, and risks particular to brow-pexy, or brow lifting. Risks of any procedure include bleeding or hemorrhage, infection, whether skin, soft tissue, abscess, or necrotizing, acute and chronic pain, and acute or chronic skin sensitivity. Delayed healing is more common is persons with vascular disease and smokers. Fluid collections known as seroma may occur in the dissected space, this typically resolves with fluid drainage. Fine results are anticipated but never guaranteed. Dissatisfaction with the cosmetic outcome of any procedure will require procedural correction.

Complications related to brow lift surgery include asymmetry, which may need surgical correction through re-operation, inadequate correction of the low brow, over-correction of the brow leading to either a “surprised look,” or even an inability to close the lids (which may lead to its own problems with the cornea, tearing, dryness, etc. and is usually a result of a combination procedure with upper blepharoplasty – persistent symptoms of this nature may require surgical reconstruction). Alopecia, or hair-loss around the incision is not a frequent complication, but is not rare, and my necessitate hair replacement or re-positioning for correction. In some cases, the endoscopic brow lift approach must be changed to the open approach. This is dictated by factors unforeseen preoperatively, such as inadequate exposure, inadequate correction, uncontrollable bleeding, etc. Contour abnormalities, divots, lumps, bumps, wrinkles may result from a brow lift. This is caused by the dissection, or by the use of a fixation device. When presenting weeks after surgery, irregularities may be a result of internal scarring. They typically resolve without issue, but may need correction in some cases. Recurrence of the brow droop is also a common negative outcome in brow lift surgery, in which case the brows need to be re-positioned. Fixation devices, as a matter of a rare complication may also penetrate the skull, and cause intracranial bleeding and/or injury necessitating emergent treatment. Visible or “feel-able” hardware may need to be removed once a stable result has been achieved. “Dog ears” are more of a possibility with the open approach, and may also require secondary correction. Scars are not particular to the browpexy procedure, but their prominence, or asymmetry if present, after this procedure may be hard to mask, and may require revision brow lift surgery or other means of making the inconspicuous. Dissection in any brow lift whether open or endoscopic proceeds in a space that is close to sensory nerves which supply or give feeling to the front scalp, and the forehead. Cutting such nerves will result in loss of sensation to the innervated skin. This is much less common with the endoscopic approach, and is guaranteed to happen for the scalp skin in the back of the incision after the open or coronal approach. Sensation usually returns without a problem. Damage to nerves that innervate muscles of the face is also possible but rare.