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Procedure: FAQ Browlift

FAQ Browlift

1. Aren't there 2 types of browlifts?

Yes, the older one is the "open" or "trans-coronal" browlift which involves a long incision from ear to ear through the scalp and sensory nerves. I don't do this anymore because of the longer surgical time, longer recovery, greater hair and blood loss. The second is the endoscopic browlift. It is the modern alternative utilizing a small camera, specialized instruments and four 2 cm long incisions within the scalp. Recovery time and possible complications are dramatically lower and I believe the results are more natural and longer lasting with this technique. Results are still "holding" strong after 10 years in my practice.

2.What do you do in a browlift?

Not only is the brow elevated in a graceful fashion, but the muscles responsible for the vertical furrows between the eyebrow are selectively removed. I also provide a subtle cheek lift in the process while making the eye a little more almond-shaped if necessary. The manner in which I personally perform this endoscopic browlift minimizes a "surprised" or "deer in the headlights" look. However, an exaggerated appearance (including Oriental-type eyes) is expected for about 2-4 weeks postoperatively. A small drain (as thin as a pencil lead) is placed and, in turn, removed the next day after surgery.

3. How is the pain?

Little to none. Numbness is the norm which dissipates after a few weeks into tingling and sometimes itching. Eventually this too disappears after a number of weeks to months.

4. Why do you have to use staples?

I don't have to, but they are actually less traumatic to the delicate hair follicles since they don't "strangle" them as the way sutures can. Consequently I prefer to use staples and they are generally removed with little discomfort at 5 days.

5. I have a "pleat" of tissue located within the hair of my temples. What are these?

These pleats reflect the lift of the deeper tissue to produce long-term effective elevation of the lateral brow. These can be hidden in your hair and are mainly felt but not seen. The pleating concept helps reduce the chance of hair loss in the temple by eliminating tension from the incision site and surrounding hair follicles . In ALL cases the pleats disappear over a few months' time.

6. When can I get my brows plucked and my hair coloured?

After 4 weeks for eyebrow plucking/waxing and 2 weeks for colouring if no peroxide is used. If bleaching or peroxide is used then it is advisable to wait at least 8 weeks after surgery.

7. Why do you recommend an endoscopic browlift as opposed to an upper eyelift?

Excess eyelid skin results from either drooping brows, true excess eyelid skin or a combination of both. 65-70% of all patients complaining of excess upper eyelid skin really have sagging brows instead. Performing an upper blepharoplasty on these patients would paradoxically pull the brow down further by irreversibly removing upper eyelid skin, thereby shortening the distance between the brow and the eyelashes. Consequently, a net downward force is exerted on the eyebrows. Hence, it is important to first establish the proper distance between the eye and the brow (akin to establishing the proper distance that a frame should surround a painting aesthetically) before deciding how much skin should be removed from the upper eyelid. However, some patients have true excess upper eyelid skin only, since their eyebrows are already positioned at the aesthetically correct level. An upper blepharoplasty is all they would need.

8. I don't want that "overdone look " with my eyes. How do you avoid that Doctor?

It is helpful to understand what contributes to the "overdone look". An eye socket that is too hollow can be responsible as well as a lower eyelid that is pulled down, showing too much white of the eyeball itself. With modern concepts of eyelid surgery, plastic surgeons can minimize this look. Fat is preserved as much as possible and muscle manipulation is minimized (to avoid weakening the muscle along with its vital support to the lower lid). If your lower lid support is naturally weak, I may tighten the lower lid surgically to preempt any lower lid sag postoperatively. Basically, plastic surgeons are a lot more conservative and strategic when it comes to eyelid surgery nowadays.

9. I am scared of the scars. Will they be visible?

The eyelid represents one of those specialized areas of the body that heal incredibly well and quickly as long as a reasonably competent surgeon performs the surgery. That is not to say that you should go to any old surgeon for your eyelids, but you should find comfort in the fact that the majority of blepharoplasties heal with little-to-no evidence of scarring. About 1-in-20 patients, however, take longer for the scars to fade. The scars may seem slightly irregularly raised in the early stages and sometimes take as long as 8 weeks before they smooth out. Don't worry if this happens to you; this is normal, just a variant of normal.

10.Why not use the laser Doctor. Won't it heal quicker?

Actually no. The best laser that produces results that compare favourably with surgical skin removal is the CO2 laser. However, healing is protracted and your skin will be pink for up to 3 months after the procedure. The pinkness always disappears, but the length of time for it to do so can be a bother. I still am an advocate of CO2 laser resurfacing, but I generally reserve it for patients who have severe wrinkling of their facial skin, including their oral area. The Fraxel?

Randal Haworth, MD
436 North Bedford Drive Suite 105
Beverly Hills, CA 90210
(310) 273-3000 (310) 273-8802 Monday through Friday, 9 a.m. to 5 p.m.