Brow Lift

The brow lift (or forehead lift) is a surgical procedure that involves subtle elevation of the eyebrows, particularly the portion of the brows over the outside corners of the eyes. The surgery also includes weakening of the muscles which pull the middle portion of the eyebrows together, an effect similar to Botox and Dysport but with longer lasting results.

Brow lifting is indicated for patients in whom the brows are in a lower than ideal position, either due to aging or genetics. The descent of the outside portions of the eyebrows can manifest itself as the hooding of excess skin over the upper eyelids.

Dr. Mehta is extremely conservative in his approach, lifting the brows in an extremely natural-appearing manner through a minimally invasive endoscopic approach. He creates 4 or 5 small incisions in the hairline and performs the remainder of the procedure using a surgical telescope, camera and monitor. There is no shaving or cutting of the hair. This state-of-the-art endoscopic approach allows for quicker recovery, decreased pain, and reduced incidence of postoperative numbness when compared with older techniques such as the coronal browlift. There are isolated instances in which other approaches to the browlift are indicated, including the direct browlift or pretrichial browlift.

The consultation

Your visit for a browlift consultation with Dr. Mehta will last approximately one hour. Dr. Mehta will begin by asking you what exactly bothers you about your appearance and what improvements you would like to achieve.

There are numerous nonsurgical treatments that Dr. Mehta utilizes extensively to treat the appearance of the brows and forehead, including Botox, Dysport, and injectable fillers. If you are a candidate for any of these treatments in lieu of or in addition to surgery, he will discuss these with you as well. Specifically, Botox and Dysport can be utilized to lift the outside corners of the brows and relax the muscles between the brows. This is a 5 minute procedure in the office and the results last for 3-4 months, on average.

Dr. Mehta will then obtain a careful history, including medical conditions that may affect your ability to undergo and recover from surgery. Any history of adverse reactions to anesthesia or medications commonly given before, during, and after surgery is also determined.

This discussion is followed by a thorough examination of your forehead and eyebrows, followed by a demonstration in front of a mirror of the effect of subtly elevating your brows. Following the examination, Dr. Mehta will photograph your face from several different angles.

After your consultation, Jill, our Office Coordinator, will assist you with scheduling your surgery, pre- and postoperative appointments and schedule a second consultation for you, should you so desire.

Preoperative Visit

After this initial consultation, you would return for a preoperative visit, two or three weeks before your surgery. At this visit, Dr. Mehta will again go over your list of medications and supplements, as it is usually necessary at this time to discontinue any products that can increase the risk of bleeding during or after the surgery. These include, but are not limited to, aspirin, ibuprofen, heparin, warfarin (Coumadin), Plavix, vitamin E, fish oil and numerous other supplements. The decision to stop any of these prescription or over-the-counter products is made in conjunction with your primary physician. Medical clearance and other tests may need to be obtained, depending on your age.

Dr. Mehta will give you prescriptions for your pain medication (or call your pharmacy) at this visit as well. This allows you to pick up these important medications prior to your surgery, so that postoperatively, you and your caretakers can rest and concentrate on your recovery. Dr. Mehta will advise you to pick up Arnica Montana and Bromelain, two homeopathic products which reduce bruising after surgery. These are taken as directed, beginning immediately after surgery. You will be given detailed preoperative and postoperative instruction pamphlets, to read prior to your surgery. It is important to minimize salt intake and avoid alcohol for three days leading up to your surgery.

Lastly, you will have the opportunity to spend time with the office coordinator, to answer any logistical questions related to your surgery. Your final surgical fees are settled at this visit as well.

Surgery

On the day of surgery, you will arrive at the surgical center with a friend or family member who will drive you home and care for you after your surgery. It is imperative to come in on an empty stomach, not eating or drinking anything for at least 8 hours prior to your surgery. This includes water and chewing gum. You should wear loose and comfortable clothing, including a shirt that buttons in the front to avoid having to pull anything over your head after surgery.

The operating room nurse will meet with you first to go over your instructions in detail. You will then meet your anesthesiologist, who will have carefully reviewed your medical and surgical history. You will have the opportunity to ask the anesthesiologist any questions you may have at this time. Finally, Dr. Mehta will meet you and your friends/family to answer any last minute questions as well.

For his brow lift surgeries, Dr. Mehta and the team of anesthesiologists use “twilight” propofol-based sedation, in which the patient is completely unconscious but breathing on his or her own throughout the surgery. This prevents the need for placement of a breathing tube, paralysis or use of a ventilator. Additionally, patients awaken more quickly after the surgery and have less nausea and “hangover” effect.

After surgery, you will awaken in the recovery room, where your vital signs are carefully monitored by the anesthesiologist and recovery room nurse. You will have ice applied to your forehead frequently during this period. You will have a few surgical staples closing the small incisions behind your hairline.

After Surgery

After approximately two hours in the recovery room, you will be discharged home, in the care of a responsible adult for the first night. Your friend or family member will check your incisions, ice your face, assist with your pain medications, and help you with your normal daily activities. You will sleep with your head elevated at 30-45 degrees. At this time, you will begin taking your prescribed medications as well as the Arnica Montana and bromelain. Eating fruits such as pineapple and papaya are encouraged as well, as they are thought to help minimize bruising.

You will return to the office the following morning to be seen by Dr. Mehta. He will check your incisions and go over your instructions in detail. Over the next 48-72 hours most patients develop mild bruising around the eyes, though pain and discomfort are usually mild to moderate. Patients are up and around as early as the next morning after surgery.

Your diet should be mild in flavor and with minimal salt for the first 10-14 days after surgery. To minimize swelling and the risk of complications, you should avoid any vigorous activity or heavy lifting for this same period of time.

Your next visit will be 6-7 days after surgery, at which time the staples from your scalp incisions are removed. Your forehead and the area around your eyes may still be somewhat swollen and bruised at this time, though the majority of the swelling and bruising disappears over the subsequent 4-5 days. On average, patients return to work or school 8-12 days after surgery though this certainly varies depending on one’s degree of bruising/swelling and comfort level.

The next visit will be at 3 weeks after surgery, at which time, Dr. Mehta will check your progress and answer any questions you may have. Your next visit will be at 6 weeks, followed by 3-6 months, at which time the “after” photographs are often taken. Typically, your future visits are every 3 months or so until the one-year mark.

Conclusion

The brow lift can yield rejuvenating results by elevating the brows to a youthful and natural-appearing position. The surgery is well tolerated by the vast majority of patients and has a brief recovery period afterwards.

Please contact us if you have any additional questions or would like to schedule a consultation.

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