Forehead/Brow Lift

If you have sagging eyebrows that create a tired or sad appearance, deep horizontal creases across your forehead, or frown lines or furrows between your eyebrows, you may be a good endoscopic brow lift candidate. To get a glimpse of the potential results, you can try a simple test on your own. Place your fingertips at the outer edges of your eyebrows and gently raise the skin upwards. This will give you a good indication of what the procedure might do for your appearance. Of course, the best way to determine if an endoscopic brow lift is right for you is by a thorough consultation with your plastic surgeon.

How is an Endoscopic Brow Lift Performed?

The endoscopic brow lift technique uses a small, pencil-like camera device connected to a television monitor. The endoscope is inserted into several small, one-half-inch to one-inch incisions placed just behind the hairline, providing the surgeon with a clear view of the muscles and tissues beneath the skin. The surgeon then inserts another instrument through one of the small incisions to lift the skin and remove or alter muscle, if necessary. During an endoscopic procedure, the eyebrows and forehead can be lifted and secured at the optimal height through the use of a new, sutureless mechanism called the ENDOTINE Forehead fixation device.

A brow lift procedure can also be performed using a traditional “open” method, where an incision is made slightly behind or at the natural hairline, beginning above the ears and continuing toward the top of the head. The surgeon works through the incision to secure tissue and modify or remove excess skin and parts of the muscle that cause wrinkling and frown lines. The incision is closed with stitches.

Because of the smaller incisions, endoscopic brow lift patients usually experience less of the itching sensation and temporary scalp numbness felt by patients who have had the open technique. In addition, endoscopic brow lift patients may feel ready to return to normal activities sooner. In some cases, a combination of endoscopic and open techniques may be used. In either case, the procedure typically takes between one-to-two hours, and is usually performed in the surgeon’s office-based facility or an outpatient surgery center under intravenous sedation or general anesthesia.

The ENDOTINE Forehead Solution for Effective Brow Elevation

The ENDOTINE Forehead device offers a novel and elegant solution designed specifically for elevating the forehead tissue in brow lift surgery. Its unique structure provides multiple points of contact with the elevated forehead tissue in order to create a more even and gentle distribution of holding strength.

Other options such as screws and sutures typically provide only one point of contact which may tear through the soft tissues, adversely affecting brow lift reliability.

Other advantages of the ENDOTINE Forehead include:

• No unsightly hair loss
• No metal screws protruding through the scalp that can cause wound irritation
• No sutures that can pinch the hair follicles, also leading to hair loss
• No need to remove, since the ENDOTINE Forehead device absorbs over time

An experienced surgeon can effectively place the ENDOTINE Forehead in less than one minute in a simple procedure. Once the eyebrows are raised to their desired height during endoscopic brow lift surgery, the ENDOTINE Forehead is inserted under the scalp tissue, securely holding the tissue in place. The incision is then closed, and the ENDOTINE Forehead is left in place, where it eventually absorbs.

‘The major difficulty we have encountered in endoscopic brow lifting is the problem of fixation” In our opinion, obtaining secure fixation is the key to predictability in endoscopic brow lifting. Not only in terms of brow elevation, but also in terms of brow shaping.

Plastic and Reconstructive Surgery Drs. Stuzin, Baker and Baker 107(3): 872, 2001

After surgery, the ENDOTINE Forehead can be adjusted if necessary, allowing the surgeon to continue to shape and contour the forehead. This provides you—and the surgeon—greater aesthetic control of your brow height and shape.

Be sure to ask your surgeon about use of the ENDOTINE Forehead device for your endoscopic brow lift procedure.

What Results Can I Expect After Surgery?

Immediately after surgery, you will experience some temporary swelling and bruising in your eyebrow and forehead areas, which may last for up to 10 days. The first night, it’s important to rest with your head elevated. You can use a cold compress to help control swelling. You may also experience mild discomfort at the surgical site, which is typically controlled with doctorprescribed oral medications. Head dressings and drain tubes (if used) are removed within a few days after surgery. You can usually take a shower and wash your hair a few days later. When healing begins, you may experience numbing and itching at the incision sites. Most patients recover from traditional brow lift surgery in about 2 weeks. Recovery time can be even faster with endoscopic brow lift surgery. At this point, you may feel the Endotine Forehead device under the skin and experience some increased sensitivity in the area until the bioabsorbable material goes away.

If you’re like most brow lift patients, you’ll be very pleased with your refreshed and rejuvenated appearance. Although it may take several months to see the final results, you’ll probably agree that your new look was worth the wait.

What are the Surgical Risks?

Each year, thousands of men and women undergo endoscopic brow lift procedures and experience no complications. Although problems are rare and usually minor, it’s best to discuss possible complications with your surgeon. And, remember that you can help minimize risks by following the advice and instructions you receive from your health care professional, both before and after surgery.

Possible Risks Associated with the ENDOTINE Forehead Fixation Device and Other Medical Implants

Although the ENDOTINE Forehead fixation device is designed for endoscopic brow lift surgery, it’s important to understand there are potential risks inherent in this and other medical implants. For example, you may experience discomfort, infection, and wound healing problems over the implant. In addition, you may be able to feel the device under the skin which may be sensitive to touch. Much less likely, but possible, is that your skin or hair may become thinner over the device, and you may experience some scarring if there is a wound healing complication around the device. At some point, you may want to remove the implant requiring a minor procedure if your sensitivity to the device is great enough that you don’t want to wait until the implant dissolves.

Since the ENDOTINE Forehead fixation device and other fixation devices used in endoscopic brow lift surgery are anchored in the bone of the skull, other risks are possible, though extremely rare. There may be complications from making the bone hole that could lead to serious injury. There is a possibility of bone infection, or the device may disengage from the bone leading to a compromised surgical result or feeling of a moving implant under your skin. And, although the ENDOTINE Forehead fixation device is absorbable, you may experience prolonged absorption time and want to remove the device, especially if you are experiencing discomfort or other problems.

Questions & Answers

Q. What areas can a minimal incision ednoscopic forehead lift improve?

A. The forehead is the “zone of expression” of our faces. As we mature, unfortunately the forehead falls, producing a tired and sometimes angry look. This results from fallen eyebrows, forehead and frown lines, and overhanging skin under the eyebrow.

Q. What Treatment is available to correct the zone of expression?

A. Customary treatment of the forehead for this problem has been a forehead lift with an incision from ear-to-ear extending across the top of the head. Now, by utilizing endoscopic, minimal incision surgery, this area can be treated with results that can equal or surpass those previously achieved by the ear-to-ear approach.

Q. What are the advantages of minimal incision endoscopic forehead lift over the traditional approach?

A.With the minimal incision endoscopic forehead lift, the hairline does not need to be altered. This is important to both women and men alike. Women benefit from the smaller incisions and the fact that their hairline is not raised, and men with partial or complete baldness who undergo this procedure can raise their brow position without a feminization of their features and without concern about scarring across the non-hair bearing scalp. Also important is the fact that there is less likelihood of permanent numbness in the incisional area with this approach as opposed to the traditional ear-to-ear approach.

Q. What can I expect from a Minimal Incision Endoscopic Forehead Lift?

A.There are a number of potential improvements, including:

• Reduction of forehead wrinkles
• Elevation of eyebrows to a more youthful position
• Reduction of hooding of the upper eyelids
• Reduction of forehead scarring and hair loss
• Reduction of residual numbness
• Reduction of swelling and bruising

Introduction

The following is a presentation to explain the endoscopic forehead lift, which describes how you can best prepare for your procedure, how it may be performed, and your recovery process along with before and after photos of some of our patients. An interesting question and answer section can also be viewed. This presentation is not intended to take the place of a physician’s consultation.

The endoscopic forehead lift, also known as endoscopic coronal plasty, is often performed in conjunction with a face lift and/or eye surgery. Your skin will be tightened, but a forehead lift will not change the texture of your skin or remove any previous scars or age spots. It can give you a more youthful appearance. Though you may consider other treatments (peel or laser) to improve the texture of your skin.

Procedure

What happens during the procedure?

This procedure takes between one and two hours. To begin, your hair will be tied back in sections. It will not be shaved but hair along the incision lines may need to be trimmed. Three to six incisions will be made of less than one inch in length each. An endoscope will be inserted through one of the incisions. Another instrument is then inserted in another incision. The forehead skin is lifted (not removed) and the muscles underlying tissue are released. The excess skin is pulled back and secured. Your eyebrows may also be lifted and secured into their higher positions by sutures beneath the surface of the skin or by temporary (absorbable) suspension devices placed beneath the skin. In addition, frowning muscles can be relaxed during the procedure as an alternative to Botox and is customized for each patient. Finally, incisions are closed with stitches or clips and the hair and forehead are washed. A small plastic tube (also called a drain) is sometimes placed to decrease swelling after surgery and is removed the following day. Gauze and/or elastic bandages may also be used to wrap and protect the incision area.

Preparation

Preparing for surgery.

Your initial consultation is extremely important. The surgeon will evaluate your skin elasticity to verify if you are a good candidate for endoscopic forehead lift. You should be able to speak freely with your surgeon about your goals and desired outcomes. Be prepared to provide your complete medical history and inform the surgeon of any vitamins and medications (including over-the-counter) that you are taking. Make sure to tell your surgeon if you smoke, have uncontrolled high blood pressure, allergies, blood clotting problems, or tendency to form excessive scars because these problems can effect the outcome of your surgery.

Review With Your Surgeon:

• Do Not Take Aspirin® Or Products Containing Ibuprofen for two weeks before or after your procedure. These medications thin the blood, interfere with normal blood clotting and increase the risk of bleeding and bruising. Instead, use medications containing acetaminophen, such as Tylenol®.
• Discontinue Smoking for two weeks before and after surgery. Smoking constricts small blood vessels and inhibits the healing process.
• Avoid Alcohol for two weeks before and after surgery.
• Decreasing Salt intake will help diminish swelling after surgery.
• Drink Plenty Of Water to help flush toxins from your body.
• Stop Taking All Vitamins And Herbs two weeks prior to surgery.
• Fill Your Prescriptions before your surgery date, especially any pain medication your doctor has prescribed for this procedure.
• Arrange For Someone To Take You Home and to assist you for 24 hours after surgery.
• One Week Before Surgery Stop sun bathing (including tanning booths), facials, steaming masks, and other skin irritants.

Post Surgery

What to expect post surgery

Work: You may feel well enough to return to work after three days but decide to wait a few more days due to swelling and bruising. Within ten days, most patients are back to their normal activities but wait a few weeks before resuming strenuous activity.

Swelling And Brusing: Keep your head elevated for two or three days following surgery while applying cold compresses or small ice packs to help reduce swelling. It is not unusual to experience a headache for 24 – 48 hours after surgery. Most visible signs of surgery should disappear after three weeks. Normal hair growth will resume in the months following.

Contact Lenses:  Contact lenses may be worn one week after surgery.

Showering: You may shower on the second or third day following surgery.

Make-up: You may begin wearing make-up after several days and hide bruising with common make-up techniques.

Discomfort: The amount experienced varies from person to person. After surgery, you will experience numbness and discomfort around the incisions. This can be controlled by the medication prescribed to you by your doctor.

Recovery: Although you should be up and about following the procedure, plan on taking it easy for at least the first week after surgery. Avoid bending and lifting after surgery. Numbness will be replaced by itching as the nerves heal. If a small plastic tube or drain was placed at the time of the surgery, it will be removed the following day. Stitches or clips will be removed within two weeks. In some cases, endoscopic surgery leaves minimal scarring, does not cause temporary numbness to the head, and may require less recovery time than is usually required for the coronal lift. The hair around your incisions may fall out or be thinner, but normal growth will resume in the following months. Most visible signs of the surgery should fade completely within three weeks. Avoid direct sunlight and make sure to put on sunscreen in the following years.

Results: Final results should be seen within two weeks. Endoscopic lifts have been performed since 1995 and is a preferred method of treatment for mild to moderate cases of the aging forehead.

Hide Scars: By allowing your hair to grow out before surgery.

To schedule an appointment to discuss forehead lift surgery in Palo Alto, San Mateo, Half Moon Bay or Los Gatos, please contact Premier Plastic Surgery