ARTE FACIAL
by Abraham Gómez, M.D.
Definition | Endoscopic brow lift
The endoscopic brow lift is an outpatient surgical procedure whose aim is to lift the eyebrows and restore their natural shape and contour without leaving any visible scars.
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Indications for surgery
The ideal candidates for an endoscopic brow lift surgery are male and female patients with heavy or low eyebrows, brow asymmetry, or the presence of excess skin that encroaches on the lateral aspect of the eyes. Patients with high hairlines or male-pattern baldness may not be good candidates for this operation.
Duration of the operation
An endoscopic brow lift procedure takes about 2 hours to perform. This time frame may vary depending on the patient’s forehead anatomy and the bony architecture of the brow region.
Type of anesthesia
Local anesthesia with intravenous sedation, also known as monitored anesthesia care or MAC, is ideal for an endoscopic brow lift. Some surgeons may prefer general anesthesia, especially when this operation is performed alongside other procedures, such as lower eyelid blepharoplasty.
Pre-surgery instructions
You will be required to have a preoperative evaluation before your endoscopic brow lift surgery. This evaluation may include an EKG, depending on your age and health status, and a complete blood count and coagulation test. Therefore, you should contact your primary care physician or cardiologist at least one month before the operation. Your surgeon will request a copy of the results two weeks before your surgery.
To reduce bleeding and bruising and help with the healing process, you must stop all medications and supplements that could interfere with clotting at least two weeks before your surgery. These include all NSAIDs, such as Aspirin, Advil, and Aleve, arthritic medications, vitamin E, omega 3 (fish oil), and herbal supplements. If you are a smoker, it is essential to stop smoking before the procedure. Most surgeons recommend stopping smoking 24 hours before surgery; however, the longer you abstain from doing so, the faster your tissues will heal. Keep in mind that tobacco interferes with blood flow to your tissues and significantly interferes with healing.
Because an endoscopic brow lift procedure is done under intravenous sedation, a complete 8 hour fast is required. If your surgery is scheduled for the morning hours, you should stop eating and drinking at midnight. This includes food, water, candy, gum, and mints. Your surgery will be rescheduled if the fast was not completed as indicated.
Diligently wash your hair and scalp the night before your surgery. You may use antibacterial soap or regular shampoo.
For your comfort, on the day of surgery, wear loose, comfortable clothing, preferably with front buttons or zipper, and bring sunglasses to the surgical facility. Doing so will make things easier at the end of the surgery, when you may feel groggy from the sedation as you leave the hospital or surgical center.
Please arrange for transportation to the hospital or surgical center and back home. Your driver must be present in the facility before the end of your surgery. It is also recommended that you have someone staying with you for the first 24 hours of your recovery.
Remember to bring a payment method with you on the day of surgery, as you will be required to pay facility and anesthesia fees. Surgeon fees are typically paid one week before surgery. You will be assigned a locker to stow your belongings before you enter the operating suite. Please leave valuables and cell phones at home or with the person accompanying you.
Post-surgery care
You should expect some degree of bruising and swelling after the operation, and it will be more evident on days 2 and 3 after surgery. Swelling is typically pronounced around your eyes. Your eyelids may swell enough to make it difficult to open them the first night, but this is not a concern and will resolve spontaneously. It is also normal to experience some blurry vision during the first week or so.
You should expect to feel some discomfort after surgery. However, severe pain is not normal and should prompt you to contact Dr. Gomez immediately. The anesthesiologist will provide you with a script for pain medication, which you should take as directed. Extra strength Tylenol or NSAIDs (ibuprofen, aspirin) are usually enough to keep you comfortable. The application of ice compresses every 2 hours for the first day also helps with pain and is always encouraged.
Keep your head elevated and abstain from lifting, bending at the waist, and doing physical activity for the first week. If you have high blood pressure, remember to take your medications to prevent dangerous complications.
Keep your head propped up with a couple of pillows or use a recliner to sleep the first week. These elevated positions help to curb swelling. Please note that you will go home with an elastic dressing around your forehead. Dr. Gomez will remove it the next day after surgery, so please leave it on overnight.
You will have surgical staples on your scalp after an endoscopic brow lift surgery. Feel free to wash the suture lines gently with baby shampoo or hydrogen peroxide once a day and coat with antibacterial ointment after drying the wound. Keep the wound free of clotted blood and scabs to prevent wound infection and encourage healing.
It is common to experience numbness or itching on your scalp after an endoscopic brow lift. These sensations may last a few weeks to several months. Most patients do not feel bothered by these symptoms, but some may find them bothersome. Fortunately, they resolve without a problem and do not require any treatment.
Regarding driving, you may do so as soon as you feel completely comfortable with your ability to drive. Do not drive under any circumstances if your vision is blurry. Wait until two weeks after the operation to resume your exercise routine or start lifting heavy objects. After the first week, a short walk once a day is allowed since it will not compromise the healing process.
Description of the procedure
The endoscopic brow lift markings are identified by three small incision lines on the top of the forehead, behind the hairline. Two other incision lines are marked on the temple area; these are also hidden in hair to avoid visible scars.
The anesthesiologist begins the intravenous sedation or puts the patient under general anesthesia at this point. The surgical sites are then prepped and draped to provide a sterile field. Once the patient has been fully sedated, local anesthesia is administered to the incisions previously marked.
Attention is turned to the temporal scalp area, where the skin is incised along the markings, and dissection is carried out without the need to shave any hair. A special camera, called an endoscope, is used to safely dissect the tissues of the forehead to the tail of the brow and to release the ligaments responsible for bringing the brow down. The central incisions, i.e., on the upper scalp, are then created, and the surgeon raises a forehead flap from the top of the scalp down to the eyebrows. At this moment, the surgeon utilizes special microsurgical instruments to weaken the muscles responsible for frown lines.
Small absorbable implants are placed underneath the forehead flap on the area adjacent to the hairline to allow permanent fixation of the brow and forehead. These implants will not be visible after the operation, but they may be somewhat palpable. They are made to resorb on their own in about five months.
The surgical incisions are carefully closed with small surgical staples. Finally, the patient’s hair is thoroughly washed and dried. Antibiotic ointment is placed on the incision sites, and an elastic pressure dressing is applied over the forehead.
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