No matter how well we take care of ourselves, facial aging is inevitable. Many patients find that their first signs of aging are around their eyes. Common complaints include feeling as though they always look tired, mad, or even sad. There can be a mismatch between one’s youthful energy and their appearance. Rejuvenation of the brow is one of the most powerful procedures that is often overlooked by both patients and doctors that helps regain a more youthful appearance to the eyes. A brow lift gets rid of what we call “lateral hooding.” This is the extra skin that forms between the outer part of the upper eyelid and the eyebrow.
A common misconception among both doctors and patients is that this excess skin is eyelid skin and they will try to remove it with an upper eyelid procedure called an upper lid “blepharoplasty” (link). Removing the excess skin from below in the upper eyelid, however, will pull the eyebrow down which is the opposite of what we want, particularly in our female patients. If you look at any youthful and attractive eyebrow in the latest fashion magazines or even pictures from your youth you will note that the tail of the brow sits higher than its root. With aging, the tail of the brow will descend and excess hanging brow skin will also form between the eyebrow and the upper eyelid. Therefore the proper treatment is to place the brow back into its youthful position where it began and this will take up the excess skin at the same time. Trying to just get rid of the excess skin from the upper eyelid may get rid of the excess skin but will pull the tail of the brow in thee wrong direction!
There are multiple approaches to surgically addressing the brow. The three main approaches include: 1) limited incision techniques (commonly referred to as “temporal brow lift), endoscopic brow lifts, and full length incision techniques (commonly referred to as a “coronal brow lift”). The full length incision techniques can be either at the hairline or within the scalp depending on how high the patient’s hairline is relative to their brow. It is important to avoid raising an already high hairline. Scarring is generally very well concealed with all the above techniques. Each of the approaches have advantages and disadvantages. During your consultation with Dr Jason, he will go over which technique best suits your particular needs.
It is also important to remember that the different areas of the face, such as the eyes, cheeks, and neck will all eventually age together and should “match” each other. It is, therefore, typically advisable to surgically correct more than one area of the face for a natural look that maintains “facial harmony”. Since most of our interactions begins with making eye contact, rejuvenation of the eyes play an important role in turning back the clock and getting the refreshed but natural look most are hoping to achieve.
Fast Facts Brow Lift
+ Length Of Surgery
Typically general anesthesia. Local anesthesia with IV sedation is also possible.
+ Length Of Stay
Done alone or with other eyelid work it is an outpatient procedure. If performed in conjunction with a facelift, a single overnight stay is highly recommended.
The Surgery Center at UCLA is the only place in Los Angeles that allows you to have your surgery followed by a monitored overnight stay with a registered nurse (R.N.) in the same facility.Not to mention, that UCLA’s world class hospital ranked “Best in the West” according to the U.S. News and World Report for the last 2 decades (add link?), is next door in the rare event of an emergency.
This allows for a safer surgical experience which is one of the main reasons Dr. Jason is proud to be on faculty at UCLA.
Initial mild to moderate discomfort; you will be up and about within the same day; wash hair 24 hours after procedure; Staples and/or stitches within the hair removed at 10-14 days; swelling, bruising mostly gone by two weeks; back to work with makeup, two weeks; avoid any exercise or significant increase in your heart rate for 2 weeks. You can start exercises that do not require leaning over or significant movement/motion of the head and neck at 3-4 weeks. Full effect and return to full activity/exercise at 2-3 months.
Inconspicuous scarring, mostly concealed in the hair or at the hairline.
+ Risks/Possible Complications
Serious complications, while possible, are unlikely. Some potential complications can be avoided by carefully following your surgeon’s instructions.
In addition to the usual risks associated with anesthesia, other risks include:
– Headaches: not uncommon but most common limited to the first 1-2 weeks
– Hematoma: Is a collection of blood beneath the skin and can be treated without compromising result.
– Brow elevation weakness or paralysis; typically temporary; permanent weakness is very rare.
– Infections are very rare.
– Numbness of scalp, can last months to even a year.
– Itching sensation in scalp
– Hair loss adjacent to incision, rare
– Pulmonary emboli: Extremely rare; a blood clot that travels to the blood vessels in the lung.
Before & After Brow Lift Photos
1) I am only 45 years old, can I be a good candidate for a browlift?
As the saying goes, “age is but a number” and facial aging is no different. There are many factors involved with how your face ages, both your genetics and environmental exposures play a crucial role. Many patients notice their first signs aging around their eyes. Therefore, there is no particular age that one should wait before considering a browlift. The procedure is effective for anyone who feels as though they have excess fullness and/or skin laxity around their eyes.
2) What should I ask during my consultation to find the right doctor for me?
You should look at the doctors before and after photos critically and decide whether you like their sense of aesthetic. Cosmetic surgery is an art and therefore you want to find a doctor that matches your taste so to speak.
3) What kind of browlift is best? What are the different types of browlifts?
There are three main approaches to surgically addressing the brow: 1) limited incision techniques (commonly referred to as “temporal brow lift), endoscopic brow lifts, and full length incision techniques (commonly referred to as a “coronal brow lift”). The full length incision techniques can be either at the hairline or within the scalp depending on how high the patient’s hairline is relative to their brow. It is important to avoid raising an already high hairline. Scarring is generally very well concealed with all the above techniques. Each of the approaches have advantages and disadvantages. During your consultation with Dr Jason, he will go over which technique best suits your particular needs.
4) How long will the effects of a browlift last?
Just as with any rejuvenation procedure, we cannot prevent ongoing aging but we can set the clock back many years! With that said, the brow lift seems to be one of the more resilient procedures we perform. It is very rare for patients to request a repeat browlift procedure in less than 20 years.
5) I have been considering additional procedures (rhinoplasty, fillers, breast augmentation, etc.). Can I have multiple procedures done at the same time?
It is possible to have multiple procedures done at the same time. For instance, including a facelift and/or eyelid procedure (blepharoplasty) with a browlift is very common. However, it is important to keep the planned operating time to less than 6-8 hours in order to optimize your safety. Increased operative times have been shown to increase the risk for complications such as infections and risk for deep vein clots that can lead to pulmonary emboli.
6) How can I control swelling after browlift surgery?
Swelling is normal following surgery. Some measures to reduce the amount of swelling include: a) Try to keep your head above the level of your heart at all times for the first 2 weeks. Dr Jason recommends a large wedge that elevates your back and your head. b) Use cooling measures such ice water soaked gauze or ice water in a ziplock for the first 48-72 hours. Your skin should just feel cool to the touch. Avoid anything completely frozen such as gel packs as this can cause damage to your skin. c) Avoid activities that involve bending over or straining. You should also minimize your salt intake as much as possible after surgery. Ideally you should ingest no more than 1-2 grams per day for the first 3 months after surgery. All of these measures combined will help minimize the amount of swelling you encounter following surgery.
7) How long will it take to heal (aka when will I be ready for a special engagement)?
One of the benefits of a brow lift is that the scars are hidden by your scalp and/or hairline. Therefore, at about 2-3 weeks the swelling and bruising has resolved and most patients will feel comfortable with attending special engagements.
8) When can I start working out again after a browlift?
For the first 2-3 weeks following surgery, you want to avoid straining (lifting anything more than 5 lbs), or getting your heart rate/blood pressure up as this can lead to bleeding. After 2-3 weeks you should avoid mechanical forces that will stress or put tension on your healing incisions for 3 months. This means you should avoid high impact activities that lead to excessive movement of your head and neck, such a running. If you feel up for it, after 2-3 weeks, Dr Jason Roostaeian recommends starting with the seated stationary bicycle which is low impact and minimizes movement of your head and neck. Listen to what your body is telling you at all times, for instance stop the workout if you experience any new discomfort in your brow area. Remember, getting plenty of rest and reducing your overall activity will give you time to heal and speed up your recovery!
9) When can I go back to work after a browlift?
It really depends on what you do for work. If you have a desk job you can typically return to work after 1 week. If your profession is more physically demanding, Dr. Jason recommends to wait at least 2-3 weeks before returning to work. Remember, you do not want to strain or lift anything that weighs more than five pounds for the first 2-3 weeks.
If you are considering facial rejuvenation, please come in for a consultation with Dr Jason. To book a consultation click here (link).
At the consultation Dr Jason will listen closely to what you are looking for and what you are trying achieve. He can also make recommendations as to what you may or may not want to consider in terms of ancillary procedures. You will also have the opportunity to thoroughly review his earlier work and see whether the results of his facelifts are what you are looking for.
Recommended Shopping List:
Button-up pajamas – to avoid pulling any clothes over your scalp and face after surgery.
Witch Hazel – Use to clean incisions in the hair to avoid bleaching.
Zip Lock bags to put ice water and keep brow area cool for swelling..
Foods with Very Low Salt- you want to really minimize salt, ideally to less than 1-2 grams per day, as this will help reduce your swelling. You want to maintain the low salt diet for at least 6 weeks and ideally for 3-6 months.
BROWLIFT Pre-Operative Do’s and Dont’s:
Avoid smoking cigarettes, wearing a nicotine patch or using nicotine gum three weeks prior and three weeks after surgery. All nicotine products inhibits circulation and slows your healing process.
TWO WEEKS BEFORE SURGERY
+ Do not take aspirin or any aspirin products. These medications cause bleeding which can lead to
complications. You may only use Tylenol.
+ If you are using Retin-A, discontinue use two weeks prior to surgery date. Do not recieve a dermabrasion, chemical peel, or laser, within five days prior to your surgery date.
+ Do not take Vitamin E (it will cause you to bleed).
+ Do not cut your hair (even your bangs) two weeks prior to surgery. Longer hair helps hide fresh incisions. Also, longer hair is easier to manage in surgery (we braid it to keep it out of the way).
+ Do not color, perm, or chemically treat your hair during the 2-week period before and after surgery. Failure to do so may result in hair breakage and hair loss.
+ Make arrangements for someone to drive you home after the doctor sees you the day following surgery.
+ It is extremely important that we are informed about any medications or supplements that you are currently taking such as diet pills, mega doses of vitamins, prescriptions for depression, etc., Dr.Roostaeian and your anesthesiologist need to know every medication that is in your system.
Browlift- THE DAY BEFORE + THE DAY OF SURGERY
+ Shampoo your hair and body with an antiseptic soap the night before surgery. We prefer you to use Hibiclens (sold at most drug stores) to wash your hair, face, and body (avoid the eyes) the night before and/or morning of surgery.
+ Do not eat or drink anything (not even water) after midnight. The morning of surgery you may take your regular medications such as blood pressure, heart, thyroid, etc. with a small sip of water.
+ Leave all your jewelry at home, including any body (pierced) jewelry. Do not wear contact lenses- not even extended wear. Remove all makeup. Do not apply lotion or creams. Bring a robe, gown (one that will slip easily over your head or one that buttons up the front) and slippers.
+ DO NOT “WORKOUT” THE DAY BEFORE OR THE MORNING OF SURGERY. This will dehydrate your body and you will not be able to replenish it with water.
BROWLIFT- What to Expect after surgery:
+ Numbness in the scalp and brow area are normal and will disappear over the next few months. Some swelling and bruising are to be expected. If you develop extreme redness, pain, fever, or sudden swelling in one area of the scalp or brow, please call the office. If you have any problems or concerns, please call us.
+ The next day after your head dressing is removed, begin shampooing your hair daily in the shower using shampoo. (This instruction will not apply to you if you have also had nose surgery.) Let the water and shampoo run over your scalp. Dont put high water pressure directly over your incisions. The goal is to keep your incisions relatively clean to decrease the chances of bacterial formation without mechanically disrupting a fresh incision. The way to manage this is to be delicate but persistent to avoid build-up.
+ Keep your head elevated 30-45 degrees for at least a week to minimize swelling. Also, do not bend over. It’s important to keep your head above your heart.
+ Clean incisions (face, eyes, and/or neck) very gently with half strength witch hazel (use tap water to dilute). Q-Tips will work perfectly to remove crusts from suture lines.
+ Do not color, perm, or chemically treat your hair during the 3-week period before and after surgery. Failure to do so may result in hair breakage and hair loss.
+ Keep animals away from your incisions. Do not allow animals to sleep in your bed for 4 weeks.
+ During the first week post surgery have a soft, very low-salt diet, no chewing and minimal amount of fluids.
+ During week two up to 3 months, maintain a low-salt diet with minimal fluids.
+ Do not consume aspirin or ibuprofen products within 2 weeks post surgery.
+ No nicotine products within 4 weeks post surgery.
+ Be very gentle when caring for your hair for 4 weeks. No brushing, pulling, or rubbing on the hair around the sutures. Do not use any heat (curlers, curling iron, blow dryers, etc.) on your hair as your scalp and face can be burned very easily.
+ No extreme temperatures on your brow or scalp such as heating pads or ice packs. Your nerve endings and blood supply in some areas have been temporarily disturbed and you can easily burn or freeze.
+ Be careful when pulling clothing over your head.
+ Avoid the direct sun or tanning spa for at least 12 weeks
following surgery as fresh scars will permanently pigment (turn brown)!