Brow Lift: Endoscopic, temporal, coronal or direct

A brow lift, or forehead lift, is a surgical procedure to reduce wrinkle lines and frown lines, and raise sagging eyebrows. As we age, our skin and muscles begin to lose tone. Forehead wrinkles and frown lines can make a person look angry or serious, or tired. If these signs of aging bother you, you may find that a brow lift will make you appear more youthful and alert.

This procedure is performed in Kaiser Permanente’s operating suite with either local, intravenous sedation or general anesthesia. There are different ways to do brow lifts and your surgeon will decide what is the best approach for you.

One method of brow lift is with an endoscopic incision. Small incisions are made in the hairline and an endoscope (a small, thin tube with a camera) and special instruments are used to adjust the tissue and muscles to correct forehead and brow wrinkles. For select patients, a direct or mid-forehead browlift incision can be used.

Another method is with a coronal incision. This is an incision created from ear to ear across the top of the head. The skin is lifted and muscles can be directly adjusted. The scar in a coronal incision is well hidden by hair. In some cases, particularly with very high foreheads, your surgeon will recommend the incision be at the hairline. A hairline scar is somewhat more visible but can be hidden with bangs.

Your Kaiser Permanente plastic surgeon will work closely with you. Be prepared to discuss your expectations and desired outcome. Make sure to address all of your questions and concerns.

Aspirin, Motrin, non-steroidal anti-inflammatory medications, and some over-the-counter herbal medications must be discontinued at least two weeks prior to surgery. These and other drugs and substances may cause excess bleeding and bruising. You can usually begin taking them again after a week or so.

If you are a smoker, it is important to quit at least four weeks prior to surgery and keep from smoking until four weeks after surgery to ensure your wounds heal properly. Your plastic surgeon will discuss this in detail with you and you will also be given a sheet with a list of common medicines to avoid for a short period. Your plastic surgeon will detail the risks associated with surgery. Plan to have a family member or friend drive you to and from your surgery appointment and stay with you for at least one night following surgery.

Following your surgery, your forehead may be taped and a light wrap will be applied to minimize swelling and bruising. A small drain may be placed temporarily to drain any excess fluid or blood that may collect. You will be given specific instructions on how to care for your incisions and drains. You should keep your head elevated for as long as your surgeon recommends.

The immediate recovery will depend upon what type of anesthesia that your Kaiser Permanente plastic surgeon will employ for the surgery. Various anesthetic agents affect patients differently and will dictate the patient’s recovery. Most surgeons will incorporate extensive local anesthesia into the tissues which can allow patients to wake up pain free. The local anesthesia will begin to wear off in three to four hours and most patients will experience mild to moderate discomfort at this stage. Pain is usually well controlled with pain medication prescribed by your doctor.

In general, you should avoid strenuous exercise for three weeks following surgery. Patients may shower the following day; but no Jacuzzi, swimming or soaking in the tub for a week. Most plastic surgeons want to see their patients back in the office five to seven days after their surgery to remove the drains which may have been placed at the time of surgery as well as to remove any sutures that do not dissolve on their own. Healing time is highly variable, but most patients’ experience moderate swelling and some bruising that can persist up to two weeks.

One of the potential risks of surgery is infection and this usually manifests itself around five to seven days after surgery and is usually effectively treated with oral antibiotics. Numbness around the incisions is normal after surgery and can persist up to several months. The actual “full” recovery period from surgery is up to a year and this involves a gradual softening and settling of the scars and tissues. A significant amount of the recovery occurs within two to three months, but it will take the external scars up to a year to fully mature.