Surgical Procedures - Facial Surgery

BROW LIFT

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A subtle lifting of the skin of the forehead often combined with some removal of underlying muscle and tissue to give a more youthful, open, positive appearance to the upper part of the face.

A 'brow lift' or 'forehead' lift can restore a more youthful look to the area above and around the eyes. The muscles and tissues that cause furrowing or drooping are removed or altered to raise the eyebrows, smooth the forehead and reduce frown lines and crow's feet. Some surgeons used to make a 'headphone' incision hidden just behind the hairline (the 'open' method) but this approach has been abandoned by most modern surgeons in favour of the 'endoscopic' technique. Using an endoscope, a viewing instrument that requires only minimal incisions, the surgeon is able to perform the entire operation though a few half inch incisions hidden behind the hairline. No hair need be shaved off and the scars heal imperceptibly. This 'scarless' upper facial rejuvenation has proved extremely popular both as an adjunct to other facial surgery and as a stand alone procedure. What can and should be done in your case will depend on a consultation with your surgeon (Please read The Consultation). However the following introductory paragraphs will, we hope, be helpful.

RIGHT FOR YOU?

Forehead lifts are most commonly performed for people aged over 40. However, they can also help people of any age who have developed furrows or frown lines through stress or over activity of the underlying muscle. Forehead lifts are often performed in conjunction with face lifts and/or eyelid surgery, especially where a patient has significant skin overhang in the upper lids. Sometimes a forehead lift solves the upper eyelid problem. The process can make you look younger and so may enhance your self-confidence, but remember it can't alter your appearance completely or give you back your youth. Please discuss your expectations thoroughly with your surgeon before going ahead.

Some Risk

Choose a well-qualified plastic surgeon and any complications are likely to be minor. However, because individuals vary greatly in their reactions and in their ability to heal, outcomes are never completely predictable. Rarely, after a brow lift, nerve injury may impair the ability to raise eyebrows or wrinkle the forehead. Hair may be lost along scar edges which is one reason why the 'open' method has been largely abandoned. Some numbness in the scalp may occur. Usually this is temporary, but may be permanent in some patients. Infection and bleeding are both possible but such complications are very rare - estimated at less than 1 percent of all endoscopy procedures. You can reduce your risk of complications by always following your surgeon's instructions closely.

PLANNING

During the initial consultation your surgeon will examine your forehead thoroughly, including the skin and the underlying bone and tissue, and agree realistic goals and expectations with you. He will ask about any medical conditions that could cause problems during or after surgery, such as high blood pressure, blood clotting problems, or any tendency to form excessive scars. Be frank with your surgeon about smoking and any drugs or medications you are taking - aspirin for example can affect clotting. Your surgeon will explain fully the techniques and the anaesthesia he will use, where the surgery will be performed, and the risks and costs involved. Be sure to ask any questions you may have about discomfort, healing time and so on.

PREPARATION

It's important you follow the surgeon's instructions on how to prepare for surgery. They may cover eating, drinking, smoking, and taking or avoiding certain vitamins and medications. If you are a smoker, it's especially important that you stop at least two weeks before and after surgery; smoking inhibits blood flow to the skin, and can interfere with the healing. If your hair is very short, you might want to grow it out before surgery, so that it's long enough to hide any scars while they heal. Even if you are only an outpatient arrange for someone to drive you home after your surgery, and to help you out for a day or two afterwards.

ANAESTHESIA

The Hurlingham Clinic and Spa offers a modern, patient-friendly approach to anaesthesia TIVA - Total Intravenous Anaesthesia. TIVA, is a newer anaesthetic technique which has risen in profile within the last 5-8 years. It has been made possible with the advent of a new generation of intravenous medications with unique properties. TIVA patients sleep soundly during the entire operation, feeling no pain and experiencing no anxiousness. They wake up quickly and comfortably with no memory of their procedure. Many patients prefer this type of anaesthetic to traditional general anaesthetics since they feel comfortable, wake quickly, have less nausea, experience none of the 'hang-over' effect of a full general anaesthetic, and therefore can be discharged earlier. TIVA is safe, effective, extremely well tolerated and is the anaesthetic of choice of Hurlingham Clinic surgeons and most of their patients. Read more about TIVA

Alternatively, for some patients, they and their surgeons may decide that a full general anaesthetic is still the best choice. Discuss your options for anaesthesia during your consultation with your cosmetic surgeon.

WHAT HAPPENS?

In an endoscopic forehead lift the hair is tied back from the intended incisions behind the hairline. Your surgeon will make not one long incision but three, four or five short ones in the scalp, each about half an inch long. An endoscope, a pencil-thin camera device connected to a television monitor, is then inserted through each incision in turn, so that the surgeon can see the muscles and tissues beneath the skin. Some of these he then removes to produce the smoother forehead. Eyebrows may also be lifted slightly and secured for a long-term fix. After the incision has been closed with stitches or clips some plastic surgeons use no dressings at all while others cover the incision with gauze padding and wrap the head in elastic bandage for a time. With high or receding hairlines, the incision may be made along the actual hairline to avoid adding even more height to the forehead. For patients who are bald or have thin hair, a mid-scalp incision is likely to be the best place for the resulting scar since least visible. A small rubber drain may be left in place which will be removed the next day.

AFTER SURGERY

Forehead lift patients may experience numbness and temporary discomfort which can be reduced by prescription medication. You may be told to keep your head elevated for two to three days following surgery to control swelling. Any swelling that affects the cheeks and eyes should begin to disappear in a week or so. Itching may replace numbness along the scars as the nerves heal and may take as long as six months to disappear. Any bandages can come off a day or two after surgery and most stitches or clips will be gone within ten days. Some hair around the incision may fall out and may temporarily be a bit thinner but normal growth will usually resume within a few weeks or months. Serious permanent hair loss is rare.

RECOVERY

Hurlingham Clinic Brow Lift Post-operative care is a key part of your surgeon's work. Follow the advice. Although you should be up and about in a day or two, plan on taking it easy for at least the first week after surgery. You should be able to shower and shampoo your hair within two days. Most patients are back to work or school in a week to ten days. All strenuous activity (sexual relations, heavy housework, aerobics ) should be avoided for at least two weeks but walking and mild stretching exercise are fine. By ten to fourteen days after surgery most patients can return to work. Most visible signs of surgery will be gone after about three weeks and special camouflage make-up can mask anything that remains. By the third week, you'll look and feel much better but may still tire easily. For several weeks avoid alcohol, steam baths, and saunas. For several months limit your exposure to strong sunlight.

HAPPY?

Most patients are extremely pleased especially with the newer methods. Patients often don't realize how old their sagging, frowning forehead has made them look until they see how much younger they appear after the lift. This procedure does not stop you ageing, of course, but it can help you look younger, feel brighter and more optimistic.