At Alexander Cosmetic Surgery, the Brow Lift is one of the procedures we commonly performed for facial rejuvenation. Dr. Alexander II trained in endoscopic (minimally invasive) procedures when the technology was just in its infancy, and became very skilled at the procedure, performing over 50 such procedures in his first year of practice.

Most patients are pretty satisfied with how they look, they’re just not happy with the changes of age. Patients don’t want to look different, or changed, just fresher and younger. Most just want to turn back the clock several years. Many patients comment that they look older than they feel, but are wary of cosmetic eyelid surgery, especially if they've seen poor outcomes in others. We often hear, “I don’t want to look funny, or surprised.”

We have all seen celebrities, friends, or people on the street with an overdone, surprised surgical look. You will be relieved to know that this “look” can easily be avoided, and does not happen accidentally. This unnatural look is usually caused by a couple of avoidable issues.

First, when patients receive a consultation for heavy upper eyelid skin, plastic surgeons too often recommend, and perform, brow lifts in conjunction with upper eyelid surgery because a brow lift is also successful in removing unwanted eyelid skin. However, this can frequently result in a brow that is too elevated and unnatural. This procedure can artificially create a rounded, hollow look to the orbital area actually making a patient look older.

A WORD OF CAUTION: The Brow Lift is probably the procedure that is most commonly over-recommended by plastic surgeons. When performed on a patient who doesn’t really need it, it risks giving the face an unnatural, surgical look. When you see a patient who looks surprised or like they have had obvious, overdone eyelid surgery, it is usually a Brow Lift that is to blame.

In our practice we are careful to recommend Brow Lifts only for patients who have very obvious indications for having one. Often, eyelid surgery, which is less expensive and simpler, is all that is required to improve the upper eyelid area.

Procedures often performed in conjunction with a Brow Lift to rejuvenate the face are QuickLift™, Eyelid Lift, Chemical or Laser peels to smooth wrinkles, frown lines and sun-damaged skin, and fillers, such as your own fat to fill deep lines. Botox® is also used to relax forehead lines.

There are several important factors to choosing a surgeon, including recommendations from friends, personality, physician training and board certification, and experience.

Referral from Friends: Many prospective patients find confidence if they have a close friend or other trusted individual who has already undergone a successful procedure. This is often a good first step in making a decision. However, not all patients know someone who has had surgery. Most of our new patients are referred by their friends who are satisfied patients.

Personality: It is important to develop a good relationship with a surgeon, where communication is easy and trust can be developed. A patient needs to completely comfortable and intuitively conclude that they are in good hands. Bedside manner is important in creating a trusting relationship.

Training and Certification: In years past, only plastic surgeons performed facelifts. However, in recent years doctors from many different specialties are more commonly performing cosmetic surgery procedures, including Ear, Nose, and Throat doctors (also known as otolaryngologists and facial plastic surgeons), Dermatologists, Ophthalmologists, and Gynecologists. Only a surgeon who has completed residency training in an accredited training program can become certified by the American Board of Plastic Surgery. There are many Boards, and it is easy for patients to become confused, or assume that when a doctor says they are “Board Certified” it all means the same thing. BE CAREFUL! Learn more about the significance of Board Certification here.

Experience: Finally, consider the physician's experience, the most important factor in making a decision. As with all professions, expertise is directly proportional to experience, meaning the total number of procedures performed. Medical literature illustrates that biggest predictor of success in surgery is volume, in other words, the number of times that a doctor has performed a procedure.

If the doctor is recommending a specific procedure, how many has he performed? How often does the surgeon perform this procedure?

While board certifications and training are important, a surgeon's experience with the procedure itself is more important. Don't hesitate to ask pointed questions about recommended procedures.

Who Is a Good Candidate for a Brow Lift?
Brow Lift surgery is usually performed on adult men and women who have healthy facial tissue and muscles and have realistic goals for improvement of the brow.

Good candidates are:

• Healthy individuals who do not have a life-threatening illness or medical conditions that can impair healing
• Individuals with a positive outlook and specific goals in mind for brow surgery
• Individuals without serious eye conditions

You should tell us if you have any of these medical conditions:

• Glaucoma
• Dry eyes
• Thyroid disorders such as Graves’ disease and under or overactive thyroid
• Cardiovascular disease, high blood pressure or other circulatory disorders

But because every case is unique, the only way to accurately determine which procedure is best for you is to consult with Dr. Alexander. Also, there are many options to rejuvenate the structures around the eye, making the eye look younger and more rested.

To ensure the most natural looking results, it's imperative for a surgeon to recommend the procedure which most appropriately matches the patient’s needs and to offer realistic expectations for post-surgery outcomes. When you meet with a surgeon, you should expect a full discussion of the surgically appropriate options for your face, which is uniquely yours.

A good surgeon goes through a series of examinations and observations that are individual and dependent upon your specific situation and goals, but also factor in the surgeon's expertise, training and experience. Be wary of the “one-size-fits-all” approach.

This is particularly important because as medicine has advanced, patients have more options available.

What to expect during your consultation
The success of your Brow Lift depends very much on your complete candidness during your consultation. We will ask you questions about your health, desires and lifestyle. Be prepared to discuss:

• Why you want the surgery, your expectations and desired outcome
• The options available to you for facial rejuvenation
• Medical conditions, drug allergies and medical treatments
• Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
• Previous surgeries

We may also:

• Examine and measure your face.
• Take digital photographs for computer imaging
• Discuss your options and recommend a course of treatment
• Discuss likely outcomes of a Brow lift and any risks or potential complications
• Discuss the anesthesia options available

Other procedures can further enhance the outcome of a Brow Lift. They include:

• Eyelid surgery to rejuvenate the eyes
• Resurfacing techniques to improve the tone and texture of forehead skin
• Fat transplantation to the frown lines

Prior to surgery, we will have you:

• Take certain medications or adjust your current medications
• Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding
• Stop smoking well in advance of surgery

During a Pre Operative appointment, usually 1-2 weeks before surgery, we will:

• Get lab testing or a medical evaluation
• Tell you what to do on the night before and morning of surgery
• Discuss the use of anesthesia during your procedure
• Explain post-operative care and follow-up, and what help you will need after the procedure

There are several methods to raise the eyebrows and weaken the muscles that cause frowning:

• Coronal (Open) Brow Lift—This requires an incision all the way across the top of the head. It takes more time, is associated with more bleeding, scarring, hair loss, and numbness. It is not performed very often, and usually only by surgeons who have not become adept at the endoscopic technique.
• Endoscopic (Closed) Brow Lift—Using several small incisions, a video camera is inserted allowing Dr. Alexander to gently loosen the brow tissues. The forehead is rotated up and secured into place. The procedure is quicker, has essentially no scarring, blood loss, or numbness.
• Direct Brow Lift—Occasionally it is very effective to remove a small ellipse of skin above each eyebrow. This is most commonly done in men who have lost hair.
• Anterior Direct Brow Lift—This is done for patients, usually women, who already have a very tall forehead, and who risk increasing the length of the forehead with a standard technique. By making an incision across the front of the hairline, the brow can be lifted and excess forehead skin removed at the same time.

Medications are administered for your comfort during the surgical procedure. The choices include local anesthesia, intravenous sedation and general anesthesia. We will recommend the best choice for you based on your personality, your desires, and the complexity of your procedure.

Endoscopic Brow Lift. The procedure typically takes about 30-60 minutes to perform, depending on the individual face and certain surgical variables.

There are four basic steps to an Endoscopic Brow Lift.

Step 1 – Incisions
Three to five 1 cm incisions are made at the hairline.

Step 2 – Loosening
After a small camera is inserted, blunt surgical instruments are used to free the brow tissue, making it more mobile.

Step 3 – Myectomy (muscle separation and removal)
The corrugator muscles that cause frowning are divided and partially removed, to create a more smooth brow.

Step 4 – Fixation
The brow is elevated and secured at an elevated level, providing a lift to the eyebrows. Brow elevation may be maintained by the use of:

• Permanent or temporary sutures
• Tiny surgical screws
• An absorbable fixation device placed inconspicuously at the temple

Step 5 – Closure
Small sutures are used to close the incisions, and a soft, compressive dressing is placed.

Important facts about the safety and risks of brow surgery
The decision to have a brow lift is extremely personal and you'll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable.

Pain
Pain from the brow surgery is usually minimal. Occasionally patients have a headache that can last over night. Pain pills are provided, but are usually not required for more than a couple of days. Significant pain is extremely rare and may be the sign of a serious complication, so your physician should be notified.

We will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks and potential complications.

The risks include:

• Unfavorable scarring
• Bleeding (hematoma)
• Infection
• Poor wound healing
• Anesthesia risks
• Correctable hair loss at the incisions
• Elevated hairline
• Facial nerve injury with weakness or paralysis
• Facial asymmetry
• Numbness or other changes in skin sensation or intense itching
• Changes in skin sensation
• Eye irritation or dryness
• Pain, which may persist
• Skin contour irregularities
• Skin discoloration and swelling
• Sutures may spontaneously surface through the skin, become visible or produce irritation that require removal
• Possibility of revisional surgery

Be sure to ask questions: It’s very important to ask your surgeon questions about your procedure. It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with us.

Although our society is increasingly geared toward instant gratification, rushing the healing process is never a good idea. It’s easy for patients to get a little too active too quickly. The body has its own pace, and your body's recovery speed is unique to you. As with any procedure, we have specific guidelines for preparation and recovery.

Recovery times vary from patient to patient. Brow Lift recovery tends to take about 4-10 days, with the average patient looking very good at about one week. Bear in mind, however, that these are averages. Some individuals may heal much more quickly, while others may take longer to fully recover. A patient who tends to have more bruising and swelling than normal will take longer to heal.

Most patients should allow one week before returning to work and other normal day-to-day activities and about two weeks before working out.

Be careful
Following your doctor's instructions regarding medications and other post-operative measures is key to a quick recovery. Herbal medications are available to reduce swelling, bruising, and to speed your recovery.

It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Avoid wearing any clothing that must go over your head. We will give you specific instructions on how to care for yourself.

When you go home
Be sure to arrange for someone to drive you to and from surgery and to stay with you for at least the first night following surgery.

When your procedure is completed, your head will be snugly wrapped to minimize swelling and bruising. It is normal for the head to feel tight. Although a bandage is not absolutely necessary, it greatly decreases swelling and speeds your recovery time. It is also a reminder to take it easy for the first day. If you become claustrophobic or uncomfortable, the bandage can be removed at any time. Cold compresses are then applied for the first 48 hours.

You will be given specific instructions that includes:

• How to care for the surgical site
• Medications to apply or take orally to aid healing and reduce the potential for infection
• Specific concerns to look for at the surgical site or in overall health
• When to return to the office

We will see you the day after surgery, then on the 4th or 5th day to remove your sutures, and then again at 7-10 days. At one week you can resume normal activities. At two weeks you can begin light exercise, and at three weeks there are no restrictions.

The results of brow lift surgery will appear immediately, and usually the brow will appear to be a little too high at first, because it always settles with time.

It's natural to feel impatient about seeing the “new” you, but you'll need to be patient as your face heals from the surgery. Your final results will appear 2-3 weeks. Once healed, the incision lines from a Brow Lift are invisible in almost all patients.

Because we have worked with so many patients, we can look at someone relatively early in their recovery and say, "You look great," even though that patient can only see how they look that day — not how they will look a few weeks later. Your final result should not only restore a more youthful and rested appearance, but also help you feel more confident about yourself.

After a few months pass it is not uncommon for patients to become so used to their new appearances that they barely notice the change. This is similar to when you get a new haircut and can't help but notice your reflection every time you pass a mirror. After a few months, your self-image resets, and you may not recall how drastic the change is until you happen upon an old photograph.

If our patients tell us they’re receiving a lot of compliments, but nobody knows they’ve had surgery, we feel like we’ve achieved our goal. And one of the ways we do this is by keeping things very simple and conservative. Some surgeons overplay their artistic ability and make recommendations that really change a person’s eyes and make them look quite a bit different than they used to. Our goal is to not change a person’s appearance, just to give them a better version of what they already have.

In general our patients are very pleased with their Brow Lift results. The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. Small revisions are occasionally necessary.

Continuing a Skin Care program can help maintain your result and help keep your skin young and healthy. We offer a complimentary facial after your procedure to introduce you to our Aesthetician, Leanne, and our Physician Assistant, Joanna, in our excellent Skin Care Clinic.

Life-long sun protection will help to maintain your rejuvenated appearance by minimizing photo-aging or sun damage. In addition, a healthy lifestyle will also help extend the results of your rejuvenated, more youthful appearance.

A quote will be provided to you after your consult with Dr. Alexander. Cost is always a consideration in elective surgery. We offer patient financing plans, so be sure to ask.

Costs include:

• Surgeon’s fee
• Operating Room and Supplies
• Prescriptions for medication
• Medical tests
• Anesthesia fees

• Anesthesia—General: The patient is asleep, requiring that the airway be protected, either by a standard breathing tube, or by a laryngeal mask (LMA), an inflatable mask that goes in the back of the throat but doesn’t go down the trachea. Through the airway, an anesthesiologist gives gases to put the patient asleep. Drugs may also be given through the iv.


• Anesthesia—Local: The surgical area is numbed up with an injection, but the patient is awake. Sometimes a patient will be given an oral medication, like Valium, to help with relaxation.


• Anesthesia— Sedation (Twilight): The patient is made sleepy with medications given through an iv. The level of sedation can be adjusted, from barely sleepy to very sleepy. Sometimes sedation is given by the surgeon, but most of the time it is administered by an M.D. Anesthesiologist.


• Blepharoplasty: Eyelid surgery to improve the appearance of upper eyelids, lower eyelids or both.


• Brow lift: A surgical procedure to correct a low-positioned or sagging brow. Smooths furrows across the forehead and between the brows.


• Endoscope: A surgical video device sometimes used during brow lift procedures.


• Skin resurfacing: Treatment to improve the texture, clarity and overall appearance of your skin.