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.