The Aging Forehead

There are three characteristics of the aging Forehead: Deep transverse lines in the forehead; very active frown and worry lines between the eyebrows; and finally, the descent of the brow also called eyebrow ptosis. This ptosis also leads to a fullness or excess of upper eyelid skin creating an unsightly skin fold and hooding of the eye that may impair your peripheral vision. Please refer to the Link on Eyelid Surgery or Blepharoplasty.

The cause of the aging brow is due to several factors. The most important is your heredity. If your parents or older siblings had early aging in their forehead with any or all of the above listed signs, there is a good chance that you too will have these changes.

Although there is nothing you can do to permanently alter the course of this phenomenon, there are several steps that might delay the full blown picture of the aging Forhead and Brow Ptosis. Practice relaxing your frown mechanism. This over reactive group of muscles known as the corrugators and procerus create a knitting together and descent of your brows. By focusing in on this group of facial muscles you can, through a form of biofeedback, train yourself not to react to unpleasant or serious situations by frowning. Another method, would be the temporary reduction of frowning by the use of Botox. This is a paralytic agent that can be used to selectively prevent frowning.

In time, however, you may wish to consider a Forehead and/or Brow lift that will permanently repair the effects of the aging brow. This link will use the term Forehead Lift when the procedure is performed open, without the endoscope. A Brow Lift will be used when referring to the closed or endoscopic procedure. In the literature the terms are used interchangeably. Although there is a difference which will be pointed out, many of our patients have come to refer to this surgery as a "Brow Lift."

The Forehead Lift

The Open Forehead Lift has been used for over 30 years to reverse the cause and effect of the aging brow. This surgical procedure is performed through hidden incisions in the scalp. The Forehead Lift releases the Frown Muscles (corrugators and procerus), elevates the eyebrows, and releases the muscles causing the transverse wrinkles in the forehead skin. In the classic case of brow descent associated with a tired wrinkled forehead, it is still the procedure of choice today. The other indication for the Open Procedure is in those patients with a high forehead. The procedure can be designed so that the hairline will not be elevated. In some cases, the hairline may be lowered, thus reducing the height of the forehead. This procedure is performed alone or, many times, in conjunction with other facial plastic surgery such as Blepharoplasty (eyelid surgery), facelift, or laser resurfacing. The procedure requires approximately one hour to perform.

The Endoscopic Browlift (closed forehead lift)

This is an exciting new procedure made possible by the incredibly small lenses and camera created for endoscopic surgery. The endoscope has been used for years by orthopedic surgeons doing knee repairs and the General Surgeons performing Laparoscopic Cholecystectomies (gallbladder surgery) and other intrabdominal procedures. The endoscope has been further modified for Plastic Surgery enabling the browlift to be performed through tiny, hidden incisions within the scalp.

With the endoscope, the frown mechanism (corrugator and procerus muscles) is released and the eyebrow is elevated. Special fixing devices are used to hold the brow position, until the body's natural tissues adjust to and maintain the new brow position. The operation takes approximately one hour to perform. The Endo Browlift is frequently performed with other facial plastic surgery such as Bepharoplasty (eyelid), facelift, and laser skin resurfacing. The main difference in indication for this procedure as opposed to the open forehead lift, is the presense of heavy transverse forehead lines or high forehead which will not be corrected. Despite this, it is more frequently requested and performed than the open procedure.

Preparation for Surgery.

Any patient over forty may be asked to see their internist for medical clearance. Special tests will be requested of all patients to insure that they are healthy and that there will be satisfactory healing. Smoking and aspirin ingestion is prohibited for two weeks before and two weeks after surgery. Aspirin will cause more bruising and bleeding, thus prolonging the recovery period. It has been found that smoking may lead to delayed healing and more noticeable scars. Occasionally, a hyperbaric oxygen treatment is recommended for smokers to prevent postoperative complications.

You will be given prescription for homeopathic and pharmaceutical preparations to prepare your system for surgery.

Anesthesia

We are recommending General Anesthesia for our patients, so that there is complete rest, safety, and no discomfort during the procedure. You will have an opportunity to discuss these options with Dr. Sokol and our Anesthesia staff.

Procedure

You will enter the Nova Surgicenter through a private and discreet entrance. After routine charting is accomplished, you will meet with Dr. Sokol. He will review your photos with you and with a mirror explanation and your input, he will point out the areas of aging in your forehead brow and other facial areas if these are also to be repaired. He will then mark the areas to be operated with special indelible ink. The anesthesiologist will then prepare you for surgery with all the special monitors, medicines and equipment to ensure the procedure is not only safe for you, but comfortable as well.

The surgical incisions will be made in the hidden, hair bearing areas of your scalp. They, generally will not be visible postoperatively as they will be camouflaged by your own hair. Occasionally in the balding patient or one with a high forehead modifications of the incision are made to take advantage of your anatomy and hair pattern.

Postoperative Period.

Recovery Room

Following surgery you will be moved into our recovery area. A trained nurse is present at all times to ensure that your vital signs are stable. In addition you are placed on a specially designed bed with continuously circulating warm air to increase your sense of well being and comfort. Constant attention is given to your operative area to make certain there are no complications. If there is any question, Dr. Sokol is just steps away and will check your wounds. After a period, not less than two hours, you will be released by the anesthesia staff and transferred out of the recovery room to your waiting transportation.

After Care

After Care Facilities - Many patients elect to use an aftercare facility in a nearby hotel. These are fully staffed with 24 hour expert nursing care. All patients using these facilities have had cosmetic surgical procedures. Thus the nurses are experienced with the needs of this surgery and highly attuned to your privacy and comfort. Meals and transportation to your postoperative visits are provided. You will be seen by the nursing staff the next day for a dressing changes and to inspect your operative area. The nurse will arrange for your next visit.

If you live less than one hour away from the office, you may wish to go home with a family member or friend who can devote the time to you. If you prefer, a home care nurse which will be arranged for you. If you live more than one hour away from the office, you will be advised to stay in a nearby hotel with your nurse, friend or relative. Our nursing staff will see you the next day to inspect your surgical site and change your dressings. Thereafter, you may return home until your next scheduled office visit.

Pain

Many patients experience little or no pain following surgery. Special medicines are utilized during the procedure to prevent postoperative pain. Everyone is different, however, and you may feel some discomfiture. You will be provided with a prescription for pain pills that will assist you during the first 48 hours. This is the period that some patients experience pain. Most bruising and swelling in the forehead will be gone by day seven. Numbness in the forehead and scalp is normal for the first 6 weeks to 6 months, and on occasion, for up to two years. The return of sensation may be associated with an occasional nerve paresthesias characterized by minor electric shocks or crawling sensations. These are good signs, signaling an early return of forehead sensations.

Activity

It is recommended that for the first 3-4 days that you sleep on your back with the head elevated on one or two pillows. This will reduce the swelling and lead to a more comfortable and shorter postoperative period. No bending over, and you are to keep your head above your heart at all times. Cold compresses are recommended for your eyelids. The first two days, they should be used continuously when you are not sleeping. For the next two days, one hour three times a day. Thereafter, cold and warm may be alternated for an additional day or two. It is normal for you to have bruising in your eyelids following browlift, even if your eyelids weren't operated on. The swelling will be maximal on day number two. Sometimes patients will be unable to open their eyes during this period. This is not to be of concern to you, as it is considered normal. Special drops and ointments are prescribed. The ointment is recommended at night and the drops three times daily, both for three or four days. You are not to read anything for two days. Television is all right as your eyes do not go from side to side as they do in reading.

No exercise, intimacy, emotionally charged situations, or alcohol is permitted for the first 7-10 days. No smoking is permitted for 14 days. This will insure a safer, shorter postoperative period, without increased bruising or delayed healing.

Although every patient heals differently, makeup is generally allowed once the swelling has receded unless other facial surgery has been performed. The sutures (or staples) are removed by day 10. A return to your employment or social schedule can occur as soon as you are comfortable with you appearance. We generally recommend that the patient take off, at least 7 to 10 days.

Complications.

Complications are rare after a forehead or brow Lift. Some of the more well known are bleeding or hematoma, infection, and irregularity of healing. The latter are the more severe and consist of blindness, inability to open or close the eyelids, forehead asymmetry or paralysis and permanent numbness. These complications may require further operative and or non operative treatment. Dr. Sokol's patients have not experienced these serious complications. In general, these long-term or permanent complications are quite rare but may lead to permanent unfavorable results.

Results

The goal of forehead and/or brow Lift is to provide you with a more attractive, youthful forehead without the frowns or furrows between the brows.

One of the nicest compliments that can be paid to our patients is that they don't look angry, sad, or worried anymore.

Because of the new position of the brows, frequently, patients experience compliments about how youthful or beautiful their eyes appear. This is because the surgery creates an opening up of the eyelid area and an enhancement of this important part of the anatomy.