What to Expect at Your Consultation
After checking a few surgeons' backgrounds and credentials, you
will make a few consultation appointments. You will meet
with these surgeons and discuss your goals and you will disclose
all information regarding your health. These surgeons
should ask for your complete medical history in a questionnaire
you will fill out before the surgeons sees you. It is
advisable to go over any medical records to refresh your memory
prior to your meeting with the surgeon. The surgeon should
ask, but if he does not, be sure to disclose:
any allergies that you may have
disorders
past illnesses
if you are a smoker
medications, if any, you are taking. This includes vitamins,
herbal supplements, over the counter medications, etc.
You should not take any aspirin containing products at least 2
weeks prior to any surgery. See Medication & Supplement List for an extensive, but
partial, list of medications to avoid before surgery. If
you are taking any of the listed medications advise your surgeon
and anesthesiologist so that they can take note of it or have
you cease consuming them.
You will discuss your complaints and concerns and discuss the
techniques and incision placements or methods that may be most
appropriate for you and should discuss the risks
associated with brow lift with you, as well.
You will also discuss the available anesthesia that will be used
for your procedure. Most brow lift procedures are
performed under Light Sleep Sedation or General anesthesia.
Either way, discuss this beforehand as many people are not aware
of the risks of Anesthesia. If you do go under Deep
General, ascertain that the anesthesiologist is certified or
that a doctor of anesthesia will be present.
Please read the All About Anesthesia Page - the risks
regarding anesthesia should be considered for a fully informed
choice.
You will discuss where the surgery will be performed as well as
after care and post-operative visits. Discuss with your
surgeon your vision problems, as sever brow ptosis (sag) can
impede vision and is usually covered by health insurance.
You will also discuss fees, medication costs and any hidden
costs that may arise. He or she will discuss with you all
of the aspects of surgery, and if a brow lift only will
rejuvenate your appearance. You may consider other
procedures such a fat grafting or a
chemical peel for increased rejuvenative properties.
If you would like more information on Consultations or a list of
questions to ask your surgeon please visit the
Consultation Help Page. If you should choose to book
or reserve a surgery date you will usually give a deposit to
hold your surgery date. Most times if you cancel a few
days beforehand, this amount is non-refundable, so be sure if
you are unable to make your surgery date to cancel well in
advance. After paying your deposit and scheduling a
surgery date, you will also schedule a pre-operative
appointment...
Your Preoperative Appointment
This appointment addresses more questions you may not have
thought to ask at the initial consultation, such as more
surgical details, concerns and even ascertaining that your
surgeon is aware of what you desire from your procedure.
Just as your surgeon will make certain that you know what it
realistically possible from this procedure.
You will also discuss your pre-operative instructions and speak
about the recovery period instructions and what to expect in the
months ahead. You will be given prescriptions for
antibiotics, pain relievers, perhaps blood pressure medicines,
prescription anti-inflammatory drugs. Remember, always ask your doctor before
taking any of these products.
Please do not hesitate to address any concerns that you may have
during this time and even after your pre-operative appointment.
If you remember something when you get home or the next day or
even the day of surgery - don't be afraid to ask.
Preparing for Your Surgery
You should be given a pre-operative information packet that
explains everything you should do and know before your surgery
date. The packet should include a list of all the
medications you should not take starting usually at 2
weeks before your surgery. These medications will include, but
are not limited to, aspirin containing products, stimulants,
seratonin supplements, etc. Would you like to view a typical
Medication & Supplements List? Also, if your surgeon
advised that you may take Arnica montana, Bromelain, Vitamin K,
etc. for swelling and bruising you should either have this in
your packet or begin shopping for your necessities.
It is quite possible that you will have blood work performed.
This is normally an extra out-of-pocket expense that the patient
must participate in to check your white and red blood cell count
(called a CBC) and check for disease or disorders beforehand.
If you are a female they may take an extra vial for a pregnancy
test. Some surgeons ask that you have physical. This
can be yet another out of pocket expense so ask at your
consultation what will be needed when you are quoted a price.
It is really important to quit smoking as soon as possible, if
you presently do. When a patient smokes there is decreased
vascularization, circulation and healing. This can
resulting in tissue necrosis (skin death), delayed healing,
complications, intense bruising, etc. Please consider
these risks.
So many things to do... so little time. Surgery will be
here before you know it so visit the
Preparing For Surgery page and relax. This section
contains, printer-friendly pre-op lists, tips and advice as well
as things you must do to prepare for your big day.
How This Procedure Is Performed
A Brow Lift normally takes from 1 to 2 hours to perform,
depending upon the technique. This operation can be
performed in conjunction with a face lift, eyelid surgery or by
itself. If you are having a face lift as well, your
surgery will last closer to 5 hours.
First, you will
have monitoring pads attached to you so that the surgical team
can properly monitor your vital statistics before, during and
after your operation. When you are brought to the
operating room, electrodes will be plugged into these pads which
are connected to the monitoring equipment.
Once you are
on the operating room table, you will then be given your choice
or your surgeon's preference in anesthesia as discussed prior to
your surgery date. If you had been given an oral sedative
or valium prior you will have less anxiety. They will more
than likely insert an IV for a saline drip to keep you hydrated
and have a vascular "doorway" for anesthesia, antibiotics, and
other medications. If you haven't been given a sedative,
it is more stressful for some patients. If you feel that
you may experience anxiety inquire beforehand regarding an oral
sedative. Having an IV inserted feels sort of like blood
being drawn, but for a shorter period of time. It's the
initial placement of the IV that may sting a bit. Some
people get heir IV placed in the crook of the elbow, some the
hand - it all depends upon your veins though. So if
your veins are not very prominent this can be a problem.
You are then brought to the O.R. if you
aren't on the table yet. After the needle is
injected into the vein it is pulled out and a little plastic
tube is left in your vein. This is called a catheter.
The catheter is taped to your skin so it is not
accidentally knocked or pulled out and is ready to be used as a
sort of entryway for anything the surgical team deems necessary
for your body. This is usually done before you get into
the actual O.R. - by a nurse - and you have a saline bag hooked
up to you. The medications will usually be given with a
drip system with this saline. As said before, the saline will
keep you hydrated both during and post-operatively.
If you have chosen an IV Liquid Sedative, they will insert a
hypodermic into your tube that you are attached to or they
attach the bag of it with a drip system to add a few drops every
few seconds and when they spring open the stopper and it starts
heading towards your body. The the effects of the
anesthesia are felt soon after injection or opening the stopper
- a few seconds in fact. It may feel similar to a sensation of
heat entering your arm or hand at the catheter site. It
then feels as though it is creeping up your arm - then it jumps
from your shoulder to a metallic-like taste under your tongue
and then you are blissfully anesthetized. The
anesthesiologist or surgeon will then determine if you are
sedated properly, your stats are stable and if you are ready for
the surgery to begin.
Your hair will either be gathered into sections with small
rubber bands or clips or trimmed and shaved, depending.
You will then be marked with a magic marker type pen for the
incision placement areas. You will then be scrubbed with
Betadine although the surgical marker markings will remain -
although not as dark. However, some surgeons mark after
scrubbing.
You will be injected with a solution of Lidocaine and
epinephrine. The epinephrine is a vasoconstrictor
and will impede your skin's ability to bleed excessively, the
Lidocaine is a pain reliever.
The incisions will follow along the surgical markings within the
hairline, or in persons with receding hairlines, in front
of the hairline. The incision length and placement will be
dependent upon the type of brow lift you will be having.
All efforts possible should be made in order to achieve
inconspicuous scars.
Your surgeon will then dissect [:
to separate or follow along natural lines of cleavage (as
through connective tissue)] the
tissues from your underlying structure, depending upon the type
of lift and desired results. This is like separating the
skin (for cutaneous-only lifts) and muscle (for full lifts) from
your skull. He will then proceed to either excise excess,
loose skin and suction or remove excess fat in the brow line
manually, or possibly atrophied muscle. Underlying
structures are then suspended by permanent sutures or "barbs" if
you are going this route. Some surgeons work on one area
at a time, some like to move back and forth checking for
possible asymmetries - it is really a matter of preference.
The surgical team then performs a sponge and instrument count
and your surgeon will then lift your skin
to the desired level of lift after excising about 1 to 3 cm of
skin, depending and either apply a tissue glue or more than
likely sutures and staples. Your
surgeon will then apply a bulky dressing to your face and head
to protect your wounds, keep the tissue in the proper place
during recovery and possibly as pressure to help with swelling
and prohibit displacement. This
involves wrapping a dressing around the top of your head to
underneath your chin, sometimes slightly over your ears.
Of course there may be differences in surgical technique
depending upon the preference of your surgeon.
You are then gently awakened and brought into the recovery room
where the recovery nurse will monitor your vital stats until you
are ready to be released. This is dependent upon the
individual but may take up to two hours or more. Your
forehead and scalp may feel tight, hot and quite tender as the
anesthesia wears off. If you feel any discomfort you may
want to ask for a pain reliever which you will more than likely
have been asked to bring with you. You may even feel
emotional or upset - this will depend upon your body's
reaction to anesthesia. You may also experience rigors or
shivering. This may feel uncontrollable and is usually
from the medications - more than likely epinephrine that is used
as a vasoconstrictor - and the cold saline which will have been
introduced into your system for the last few hours, and still
may be. The fact that the operating room is usually
very chilly, surely does not help matters in this regard.
The recovery nurse usually has wrapped you in a warm blanket but
if not, request one. Some facilities may also offer their
patients a heat lamp. These extras certainly make your
recovery more comfortable.
Some patients feel nothing different than waking up from a good
night's rest - although if you have had General you may feel a
little sick - hopefully your surgeon gave you something to
lessen this. Your prescribed medication should alleviate
any pain or discomfort. However, if you believe your pain
to be out of the ordinary once you get home, call your surgeon
or the on call staff immediately. You will be driven home
by your spouse, significant other or friend as you will not be
able to see, much less drive yourself home.
The Road to Recovery
Upon arriving at your home or hotel, you may be groggy from the
anesthetic and/or oral medications and probably won't remember
much of the first day or two. You will have to take it
easy for the first 7-14 days - or however long your surgeon
suggests. You will be instructed to keep your head
elevated for several days. Two to three medium-filled pillows
should do the trick. Take your temperature regularly.
An elevated Temperature could mean an infection. Take those
antibiotics ON TIME. Women, don't forget if you are taking
birth control pills that some antibiotics can interfere so in
the event that you do have relations, use another form of
protection as well. You are usually told to use cold
compresses to keep swelling and bruising to a minimum. Any
discomfort should be alleviated by your prescribed pain
medication if you have excessive pain, redness, pus or other
symptoms that do not appear normal, contact your surgeon
immediately.
When you wake up you will notice that your forehead will look
even more swollen in the first 3 days.
You won't usually be very swollen until late that night
or the next day and then the third day is usually the worst.
But, as the days go on the swelling will dissipate. There
may be a lot of bruising, but this will go away, as well.
So make a mental note of this or you may be shocked into a
depression. Bruising and swelling are a normal occurrence
in most surgeries. Don't worry, it is all a part of the
natural healing process. You shouldn't really look at
yourself in the mirror, but rather have your partner or nurse
care for you instead (even take photos if you wish it).
Your back will more than likely cramp up from not being able to
lie completely stretched out and flat on your back so some
patients prefer heating pads or hot water bottles.
Remember not to sleep while using any of these devices.
This can result in severe burns - especially if you are heavily
medicated and don't feel the heat or pain.
You may go in the next day for your first post-operative visit.
The surgeon MAY change your bandages or may wait until the end
of the week - depending upon the seepage or the extent of work.
Your sutures won't be removed until day 5-7 and your staples in
your scalp (if applicable) not until around day 10. Your
scalp takes longer to heal.
Your scalp will be numb - don't be afraid or worried, this is
quiet normal, remember your nerves and all have been partially
separated from their source. Give them time to recuperate - just
as you, yourself, need time to heal. Please take it easy
and try not to do too much, too soon. You should be up and
about in the first few days but don't feel guilty if you don't.
Listen to your body.
Even though you may feel better, you must take it easy for the
first 3 weeks. Be careful not to bend over or lift heavy
objects. And be careful not to raise the blood pressure
for at least 3 weeks as this could cause internal bleeding at
your treatment area. Your blood vessels dilate to allow
increased blood flow when you raise your heart rate. This
may cause problems at internal wound sites. Do not
participate in contact sports for at least 6 to 8 weeks -
although ask your surgeon what he recommends specifically.
Please continue to avoid alcohol and aspirin containing products
for a few weeks (or until your surgeon tells you) as this has
anti-platelet properties and could cause bleeding. Also
you are going to be bruised and swollen for quite some time.
If you smoked before the procedure you really should not start
back again. Smoking greatly decreases vascularity and
circulation, promoting necrosis (death) of skin, improper
healing and excessive scarring. Quit beforehand and stay
such.
You will notice a change in your eyebrow's appearance, odd
sensations of "tightness", tingling, the sporadic sharp pain, or
"pulling", burning, and cold sensations. These usually
subside within the first few weeks. Your swelling will
subside, revealing a more rejuvenated appearance.
Remember, this may take some time so please prepare yourself
emotionally. You may find that you may begin to feel sad or have
periodic bouts of depression during your recovery.
Although this is rare it DOES happen. It is usually from
the lack of activity, medications, presence of swelling and
bruising and a natural period of "let down" post-operatively.
Please see our Post-operative Depression Section for more information.
Risks & Complications of Brow Lift
Of course there is the inherent risk regarding anesthesia and
complications because of it - such as allergic reactions.
Although please read the Anesthesia Section for more information. Other risks
may be hematoma, seroma, asymmetry, infection, nerve damage, and
tissue necrosis (tissue cell death).
A very common after effect is Alopecia
[: loss of hair, wool, or feathers : BALDNESS]
along the incision lines and even hair of the head in general or
facial hair, such as eyelashes or eyebrows sometimes because of
the anesthesia and medications such as antibiotics and pain
relievers. Only about 1% (source: Rhytidectomy; Grand
Rounds, Dept. Otolaryngology UTMB, 11/06/96) report
permanent Alopecia. This may be from individual bodily
reactions, circumstances or excessive tension. Sometimes a
scar excision is suitable, sometimes this will only create
further tension.
Not all techniques have the same drawbacks or pluses - with the
coronal lift, the incision can create a higher hairline. Some
persons may not wish to have a more raised hairline. With
the Endoscopic brow lift the lift it more subtle and more
suitable for younger persons not wanting too much of a lift.
There is also a risk of failure where the sagging brow returns
to its prior position, or lapses. This is most often
seen in endoscopic brow lifts so consider this before committing
to a procedure. The risk of brow asymmetry is a reality so
be cautious when choosing a surgeon - although it is very
possible that the variations in healing of the patient can
affect this. Usually, a minor touch up can be performed
with local or regional anesthesia, in-office.
Please discuss with your surgeon the risks of a Brow Lift and
his or her risk and complication percentages.
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