BROWLIFT — FAQs
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1) Do I need an upper eyelid lift or browlift?
The brow position determines if a browlift is necessary of if just an
eyelid lift will suffice. During your initial consultation, Dr. Lopez
uses his hands to raise your forehead skin to the appropriate level.
If most of the upper eyelid skin disappears, then you would most likely
benefit from a forehead lift. If improvement is noted when the sagging
brow is lifted and excess skin remains on the eyelids, a combination of
a browlift and upper eyelid lift may be recommended to achieve a more
youthful appearance.
2) Will I have a "surprised" look if I have a
browlift?
The goal of a browlift is not to raise the brows as high as possible.
Dr. Lopez elevates the brows to a more youthful position. In women
the position is generally just above the bony arch above the eyes with
its highest point near the outside of the eye. The ideal brow
position for a man is just at the bony arch above the eye with minimal
to no arch in the brow.
3) What is an "endoscopic" browlift?
An endoscopic browlift is done by making small incisions behind the
hairline and using a telescope to perform the surgery. When the
telescope is inserted under the skin, the area is displayed on a
television screen.
In the right patient, endoscopic browlifts can have several
advantages. Along with the advantage of smaller incisions, browlifts
performed endoscopically have fewer sensation changes (less numbness and
itching), less wound care and fewer side effects following surgery.
Also, with endoscopic browlifts there is no compromise to the hair.
4) What other types of browlift procedures are
there?
Dr. Lopez uses various techniques to lift the brows. Patients with
high hairlines may benefit from a pretrichial browlift where an incision
is made just at the anterior hairline and the position of the hairline
can be lowered along with lifting the brows. In males with deep
forehead wrinkles, a direct or mid-forehead browlift can be done where
the incision is placed right in a wrinkle that hides the incision
extremely well.
Dr. Lopez no longer performs coronal browlifts where an incision is
made about 4-6 inches behind the hairline and the brows are elevated by
removing excess skin. The endoscopic browlift has replaced the coronal
browlift to Dr. Lopez’s practice because of the many advantages
discussed above.
5) Should all browlifts be done endoscopically?
Absolutely not. Dr. Lopez individualizes the procedure to each patient.
Factors that determine what kind of browlift is best for the patient
include heaviness of the brows, gender, position of the hairline and
severity of forehead wrinkles
6) How long does a browlift last?
The longevity of the benefits of a browlift is dependent on many factors
to include general health, sun exposure, tobacco use, and genetics. In
general the brows will always be at a higher position for the rest of
your life than if you had not had the surgery.
7) What's the difference between endoscopic
browlift and midfacelift?
Endoscopic browlifts have the ability to raise or lower the brow and
address the upper eyelids and part of the lower eyelids, stopping at the
bony rim below the eyes. When Dr. Lopez performs a midfacelift he is
able to provide middle face rejuvenation -including any remaining
portion under the eyes and the area of the face level with the nose down
to the teeth. With the addition of a midfacelift, the cheek is elevated;
it pads the bony rim of the lower eyelid thus necessitating less fat
removal. This improves his ability to treat lower eyelid "bags" and
rejuvenate the bony orbital rim by precisely treating the droopiness and
bagginess about the eyes in the manner that it ages.
8) Will I still look like "me" after surgery?
Many of my patients report that when they return to their normal life,
their friends comment, “You look great. Are you getting more sleep?" or
"You look less stressed and tired”. Dr. Lopez will not change the
way you look, just enhance it.
9) Will a browlift get rid of these deep frown
lines between my eyes?
Frown lines are a common reason that patients seek browlifts.. Frown
lines are more often the effect of the corrugator and procerus muscles.
Dr. Lopez will treat these muscles during the browlift surgery in order
to improve the frown lines. Some of the deepest lines may not completely
resolve, however they will be significantly improved. Dr. Lopez can add
a finishing touch with a filler or a resurfacing option to provide an
optimal result.
10) Will a browlift get rid of the horizontal
wrinkles in my forehead?
A browlift is most often performed to relocate the brow and restore it
to a more youthful position. A browlift will not remove fine lines and
wrinkles. To improve the horizontal wrinkles Dr. Lopez often
recommends Botox after the browlift is done.
11) How much pain will I have?
Most patients who have browlift surgery say how surprised they are that
the pain is less than they anticipated. Understandably, after any
surgical procedure, some discomfort can be expected. All patients are
provided with prescriptions for pain medication. Patients sometimes use
the prescription medication two to three days after surgery and then
switch to Extra Strength Tylenol. Patients undergoing a midfacelift will
have some pain on chewing for about 48 hours. It is uncommon for
patients to report unmanageable pain after surgery.
12) If I have a browlift will it also lift my
face?
When combined with a midfacelift suspension, which can be performed
through the same incisions, the procedure does lift some sagging in the
face. A midfacelift will not, however, address one of the most common
concerns of cosmetic patients which is the "turkey wattle",redundant
skin of the neck, to tighten the neckline.
13) Where are the incisions for endoscopic
browlift?
The beauty of the endoscopic browlift is that the incisions are all
hidden above the hairline. Because of incision placement, browlift
incisions heal very well and most patients and family members will not
notice them after a few weeks.
14) What if I have a history of bad scars?
If you have pierced ears, the way you healed there is a good indication
of how you will heal from facial plastic surgery. Scars on the rest of
the body typically are not an indication for how patients heal following
facial plastic surgery. At the time of your consultation, it's important
to show Dr. Lopez any previous scars that are of concern to you so he
can give you a realistic assessment of your healing potential following
facial plastic surgery.
15) Will I be awake during surgery?
Patients are asleep during the surgery either with general anesthesia or
using IV sedation (medicine administered through an IV) and a local
anesthetic (numbing medication administered in the operating room).
Patients do not hear or feel anything and are comfortable during the
operation. Patients wake up very soon after the surgery is completed.
Intravenous sedation is a type of anesthesia; therefore all patients
must have a responsible adult to stay with them through the night
following surgery. Patients may not drive for seven days following their
procedure and this time may be longer, depending on the procedure.
16) Do I go home after surgery?
Most browlifts are done on an outpatient basis. Because you will go home
after receiving sedation, you will need to make arrangements for a
responsible adult to drive you home, to stay with you overnight and to
drive you to our office for your first postoperative appointment.
Patients having surgery must stay in the immediate San Antonio area
overnight.
17) Will I bruise and swell afterwards and how
long will it last?
Unfortunately it is impossible to do surgery without causing swelling.
Dr. Lopez does everything possible to minimize the amount of swelling
that occurs. Generally, postoperative swelling begins to resolve
at the end of the first week. Bruising is extremely variable.
Patients that have a tendency to bruise will generally bruise for about
10 days. Patients that don’t tend to bruise may have minimal if
any bruising. Complete resolution of bruising and swelling
may take two to three weeks. However, bruises may be camouflaged fairly
easily at seven to ten days with a concealer stick.
18) How long should I stay in San Antonio
following surgery?
Most patients stay in San Antonio about seven to ten days following
surgery. After that it's ok to fly or travel long distances.
19) When can I return to work?
Most of Dr. Lopez’s patients take about two weeks off of work. After two
weeks, most of the residual bruising and swelling can easily be
camouflaged with make-up.
20) When can I exercise?
Dr. Lopez prefers that aerobic activities be avoided for two weeks after
surgery. In addition, heavy weightlifting or more strenuous
workouts should be avoided for three weeks postoperatively. It' is
extremely important to avoid bending, lifting or straining during the
early postoperative period as these activities can increase swelling and
delay healing.
BROWLIFT PREOPERATIVE INSTRUCTIONS
21) Should I do anything before to prepare for
surgery?
You will have a preoperative appointment with Dr. Lopez and his staff to
go over the preoperative instructions.
22) Why do I need a preoperative appointment?
This is an essential appointment to prepare you for your upcoming
surgery. Dr. Lopez will take preoperative photographs at the visit
as well as go over the procedure again to ensure that everyone is on the
same page. All questions that you have will be answered on that
visit as well. You will often times be given your prescriptions on
the preoperative visit day.
23) What else can I do to do to prepare for
surgery?
Dr. Lopez likes to have patients that have well controlled blood sugar
to drink three eight ounce glasses of pineapple juice for at least one
week before surgery. Pineapple juice can help minimize the
postoperative swelling. Patients that use tobacco will be asked to stop
for six weeks before and six weeks following surgery. Tobacco has
properties that impede wounds from healing. Dr. Lopez will
encourage tobacco users to not resume smoking at all after surgery; in
fact many of his patients have used the surgery as their motivation to
quit smoking.
24) What about my daily medications before
surgery?
In general you will be allowed to take most of your daily medications.
Medications that thin the blood such as ibuprofen, vitamin E, and herbal
supplements need to be stopped two weeks before surgery. You can
continue to take a multivitamin. Aspirin needs to be stopped three
weeks before surgery. Dr. Lopez will provide a "Medication List"
that reviews all medications and supplements to avoid prior to surgery.
25) Do I need any special prescriptions before
surgery?
Dr. Lopez will generally give you a prescription for an antibiotic, a
pain medicine, antibiotic ointment, as well as an anti-swelling
medication. Dr. Lopez does prefer patients to start Arnica, a natural
herbal substance, the day before surgery in order to minimize brusing.
He also asks you to start taking Vitamin C before surgery.
BROWLIFT POSTOPERATIVE INSTRUCTIONS
26) What does it feel like when I wake up from
surgery?
Most patients report only mild to moderate discomfort, which may be
associated with some numbness, itching, tightness or a pulling
sensation. These postoperative symptoms subside with time. We will make
sure you are not nauseated or queasy. Our nurses will be right there
with you as you wake up from surgery to give you special attention.
Patients initially experience numbness for the first six to twelve
months following surgery. About two months after surgery, it is common
to have itching or "pins and needles" as the sensation returns. This
itching is significantly less with an endoscopic browlift than a
traditional browlift. This is actually an important point because
patients who scratch or "itch" their hairline can thin the hair.
27) Tell me more about the incision.
The head wrap will be removed in the office the day following surgery.
After the head wrap dressing is removed, you will notice little clips in
your hair. Apply antibiotic ointment to the incision sites three times a
day. You will be asked to return to the office about seven days from the
surgery date for removal of clips. Because most patients tell us their
forehead is temporarily numb the removal of clips is usually not too
uncomfortable.
28) How do I look when I wake up from surgery?
Following the procedure, you will have a soft head wrap around your head
and under your chin. This helps minimize swelling. The head wrap will be
removed in the office the following day. A second dressing will be
gently applied for 48 hours to minimize swelling. You may have some
bruising, however, this typically is more pronounced 24-48 hours after
the procedure.
29) Can I do anything to prevent brusing?
Most patents will have a little bruising. We can minimize bruising by
using Arnica before and after the procedure. Arnica is a natural "herb"
that helps prevent bruising.
30) Tell me more about the sutures.
If there are sutures near your ears they will require some simple care.
We will ask you to use a Q-tip to cleanse them with peroxide once a day
and apply an antibiotic ointment three times a day to keep the sutures
soft. In six to eight days, when the time arrives for suture removal,
sutures that have been lubricated glide out easily.
31) When can I shower?
You can shower once the second dressing is removed. Make sure that you
pat dry the incisions well after the shower and apply the antibiotic
ointment.
32) What medications do I take following
surgery?
Dr. Lopez will ask you to take the following medications starting the
day of surgery:
1- An antibiotic - generally Keflex for one week.
2- Pain medicine - Vicodin or Percocet to take as needed.
3- Antibiotic ointment- to place on the incision sites at least
three times a day.
4- Antiswelling medication- for patients that are not diabetic a
Medrol dosepak will be given.
5- Vitamin C for 1 week following surgery to promote healing.
6- Arnica- place under the tongue three tabs three times a day
before meals for two weeks.
33) When do I begin taking the medications?
Patients take their pain medication as needed. Begin taking vitamin C
one week before surgery. You can begin taking Arnica the day before
surgery. The antibiotic and swelling medications begin when you arrive
home following surgery. Unless you are notified otherwise, resume all
daily medications when you arrive home from surgery.
34) Are there any food to avoid following
surgery?
No. Dr. Lopez encourages you to eat a well-balanced diet. You may
notice that saltier foods can cause you to swell for a longer period of
time.
35) When is my first postoperative appointment?
You will be asked to see Dr. Lopez on the first day following your
browlift for removal of head wrap dressing. You will need someone to
drive you to this appointment.
36) What about my regular daily activities?
Sleep with head of the bed elevated or use two to three pillows for one
week. Facial fullness, headache and disrupted sleep are very normal
postoperative symptoms and will decrease as the healing process occurs.
Absolutely no bending, lifting or straining. If you have little
children, bend at the knees or sit on the floor and let them climb on to
your lap.
37) How long does the healing take?
As numbness wears off patients experience a "pins-and-needle" sensation.
At about two months postoperatively patients experience an itchy scalp.
It is important not to scratch as scratching can thin the hair. These
sensations can take up to a year to dissipate completely. Medications
are available to be used on an as needed basis to ease any significant
sensations. Healing and evaluation of the final result takes one full
year. However, after three months, most patients have about 90% of their
final result.
38) How can I minimize the swelling and brusing?
Most of Dr. Lopez’s patients will have a little bruising. He minimizes
bruising by having patients stop all blood thinners well ahead of
surgery as well as using Arnica before and after the procedure. The cold
packs around the eyes should be used every 20 minutes while awake after
surgery to help prevent swelling and bruising. The cold packs should be
used for the first 72 hours. You do not need to wake up to use the cold
packs. A good night’s sleep is vital to healthy healing. Patients are
also asked to sleep with their head at least at 45 degrees to minimize
the swelling.
39) When will I look normal?
You will be presentable at two to three weeks. You will look great at
six weeks and even better at six months as things settle and expressions
become more natural. At three weeks you know you are well on the way to
recovery and most patients resume routine activities around two to three
weeks following surgery. Final results are evaluated at one year.
40) How often do I need to return for
postoperative visits?
Dr. Lopez likes to see his patients 3, 6, and 12 months after the
procedure to ensure that the healing is going as expected.
