Manuel A. Lopez, MD, FACS

Board Certified Facial Plastic Surgeon

(210) 495-5771 (LPS1)
(210) 495-2367          
Lopez Plastic Surgery
1314 E. Sonterra Blvd, Suite 5104
San Antonio, Texas 78258

Browlift

One of the most common concerns that Dr. Lopez hears is that patients look older than they feel. Many patients want to eliminate a tired or “angry” appearance around the eyes. Some want to elevate a “saggy” eyebrow over the upper eyelids. Other patients want to eliminate the frown lines between the eyes.

Dr. Lopez performs a browlift to restore a more naturally youthful appearance and less tired look while maintaining or improving visual function. Once thought a beauty procedure afforded only to wealthy women, many men are increasingly seeking browlift to restore a younger look that softens frown lines and the perception of scowling.

Depending on the position of the brow, a patient may need only a browlift, only upper eyelid lift or a combination of both these procedures.

Dr. Lopez uses various techniques to lift the brows. An endoscopic browlift is done by making small incisions behind the hairline and using a telescope along with endoscopic instruments to perform the surgery. When the telescope is inserted under the skin, the area is displayed on a television screen. 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 in Dr. Lopez’s practice. The coronal lift requires a significantly longer recovery time as well as a higher chance for visible scars and a longer period of decrease sensation in the scalp area.

When discussing rejuvenation procedures the best place to start is by looking at before and after photos to see just what can be accomplished. Often times other procedures are combined with a browlift. The most common request combines blepharoplasty (eyelid lift) with a browlift. Chin implants, rhinoplasty (nasal surgery), otoplasty (ear surgery), facelift, midfacelift and lip surgery can also be performed with a browlift.

Many patients seek information about improving superficial skin wrinkles. Although some improvement in facial wrinkles can be obtained from a browlift, it will not address all the superficial lines that come from premature aging, overexposure to weather and genetics. Browlifts address drooping brows; chemical peel and skin resurfacing address textural wrinkles and imperfections.

At your initial consultation, Dr. Lopez will evaluate the bony and soft tissue architecture of your face. An overall assessment of the face provides the basis for what one may expect from a browlift. Skin type, ethnic background and age, along with the degree of deformity and function are important factors influencing the outcome of an operation.

As with all facial plastic surgery, a thorough health assessment and realistic expectations are prerequisites. Your understanding of procedures and preoperative and postoperative routines is essential to a successful final result.


BEFORE BROWLIFT SURGERY

At your preoperative appointment Dr. Lopez will go over the instructions with you to follow before and after surgery. Dr. Lopez pre-treats all browlift patients with Botox to minimize the amount of downward pull that the brows experience during the healing process. Preoperative photographs will be taken and your questions will be answered. A browlift takes about one hour depending on the underlying structure and amount of excess tissue prior to surgery. If you are having a combination of procedures your surgery time will take longer. Recovery time from the anesthetic takes about an hour and most patients are discharged about four to five hours from the time of admission.

PREOPERATIVE BROWLIFT INSTRUCTIONS

  1. Please avoid any aspirin, aspirin-containing products, or ibuprofen (Advil, Aleve, etc.) for two weeks prior to and two weeks following your surgery. See our “Medication List” for products to avoid prior to surgery. If you are on any medications that affect bleeding (such as coumadin or warfarin) please notify the office immediately.
  2. Please refrain from tobacco products for six weeks and alcohol for one week prior and three weeks following surgery. Along with delayed wound healing, persistent skin redness and other complications may persist when tobacco and alcohol are not discontinued.
  3. Please notify us of all routine medications and significant health history. We ask that you remain on your daily medications unless instructed otherwise. At the preoperative appointment you will be told which daily medications to take with just a sip of water on the morning of surgery.
  4. At your preoperative appointment you will be given prescriptions for use following surgery including an oral antibiotic, antiswelling medication, antibiotic ointment and pain medications. Please obtain these prescription medications before your surgery so you will have them ready for use when you return home after surgery.
  5. We will ask you to take Arnica, a natural herb that significantly decreases bruising, before and after surgery. We will also ask you to take Vitamin C (ascorbic acid), which helps promote healing, before and after surgery.
  6. You may not eat or drink after midnight the evening before the procedure unless instructed otherwise. You may brush your teeth. Your procedure will be cancelled if you do not follow these instructions.
  7. Remove all make-up and nail polish before arriving for your procedure.
  8. Someone will need to drive you home after your surgery and stay with you that evening. Transportation to the office for dressing removal the day following surgery is also required.

AFTER BROWLIFT SURGERY

When you wake up from surgery you will notice a soft, bulky head wrap dressing. You will be asked to come to Dr. Lopez’s office the following day after surgery for dressing removal. You will be asked to return in five to seven days for suture/clip removal.

POSTOPERATIVE BROWLIFT INSTRUCTIONS

Wound care

  • Keep dressing dry and intact the evening after surgery.
  • Following dressing removal the day after surgery, you will notice little clips in your hair. We will again instruct you on wound care. Cleaning the suture with a Q-tip dipped in hydrogen peroxide and then applying the antibiotic ointment three times a day is an essential part of the healing process.
  • You will be asked to return to the office about seven days after surgery for removal of clips and/or sutures. Because most patients tell us their forehead is temporarily numb following browlift, it is uncommon for patients to complain of significant pain with clip/suture removal.

Medications

  • Most patients complain of discomfort more than pain. Use pain medication as directed/as needed. Vicodin and Percocet contain Tylenol. Do not take additional Tylenol or acetaminophen while taking Vicodin or Percocet. Do not drive or drink alcohol while taking pain medication. Taking pain medication with food helps minimize nausea sometimes associated with pain medications.
  • Start your antibiotic (Keflex) when you get home and one at bedtime. It is not uncommon to have a low-grade fever for 24 hours following surgery.
  • Vitamin C (ascorbic acid) helps promote healing. Take 1000 mg three times a day for two weeks following surgery.
  • Arnica, a natural herb that significantly decreases bruising, is used under the tongue three tabs three times a day before meals for two weeks.

Diet

Advance diet from liquids to soft food (oatmeal, French toast, yogurt, soup, pasta) to your regular diet as tolerated. You have no diet restrictions. Often the anesthesia you received can make your stomach feel uneasy for the first 24 hours so avoid large meals.

Activity

Rest for entire day after surgery. Sleep with head of the bed elevated or use two to three pillows for one week after surgery. 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. No driving for one week following surgery. Two weeks off work is recommended.

After 48 hours, you are allowed to shower and gently wash your hair. Make sure that the hair is dried thoroughly, but do not use a hair dryer for the first two weeks. Sensation to the scalp will be diminished temporarily so you want to avoid causing a burn because of a hair dryer.

Bruising can be camouflaged at one week postoperatively with make-up. Always protect your face from the sun. At this point, a hat and sunglasses are a good idea. It is ok to apply sunscreen, cosmetics or facial creams two weeks after surgery. Avoid unprotected prolonged sun exposure for three months following a browlift to prevent pigmentation of incision lines.

Tearing, bruising, swelling, eye fatigue and disrupted sleep are very normal postoperative symptoms and will decrease as the healing process occurs. Since vision is temporarily compromised, assistance with daily activities is recommended.

Final Result

Following browlift, it takes time for the swelling to subside and for the skin to heal. Most patients return to work two weeks following surgery, however three weeks is ideal, depending on the degree of privacy one is trying to maintain. At three weeks postoperatively, swelling and bruising may be apparent to you but not to many of your coworkers and closest friends.

Final results following browlift are not apparent for one full year following surgery Dr. Lopez will want to see you 3, 6 and 12 months after the surgery to ensure that you’re healing as anticipated.

 

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