Most patients seeking a brow lift decide to do something about their brows when one too many people ask them why they look unhappy. If your resting facial expression looks like a scowl because of your eyebrows, it can hurt your social interactions. The advent of Botox and other neuromodulators has definitely reduced the need for brow lift surgeries, as more and more patients opt for nonsurgical and minimally invasive methods to reduce forehead wrinkles and improve their brow position. However, there is a limit to what Botox can do. There are two specific situations where a surgical option is preferred to a Botox injection for achieving a good result.
The first is static lines – that is, forehead wrinkles that are present even when you are not raising your eyebrows. Botox only affects wrinkles caused by the muscles of the face, so it cannot improve these static lines.
The second is when the eyebrows have drooped, and at the same time the upper eyelid skin is also sagging. In this situation, a simultaneous upper eyelid surgery and brow lift is recommended to achieve a harmonious result. In this situation, performing an upper eyelid surgery alone can often make the brows appear worse!
Brow lift surgeries generally hide the incisions within your hair, and they are almost invisible as a result. Depending on the specific nature of the brow lift you need, Dr. Nagarkar may perform it in a minimally invasive manner, with a endoscopic camera and instruments placed through smaller incisions.
The brow lift, like eyelid surgery or a face lift, can very dramatically change your appearance.
The dramatic change needs to be one where you suddenly look fresher, younger and happier – not where you look perpetually surprised. My aim with a brow lift is to be like the “b” in subtle, and not like the “t”. A beautiful brow should appear natural and youthful and should fit your face. There is no single ideal brow shape or position – my goal is to design the surgery to fit you, and not the other way around.
Who is a good candidate for a brow lift:
Most patients who are in generally good health can be appropriate candidates for a brow lift. High blood pressure, which affects so many people, must be well controlled before surgery.
How to prepare for surgery:
Most patients will need to visit their primary care doctor for a pre-operative physical and get clearance for surgery. If you are a smoker, you must completely stop smoking and refrain from any nicotine-containing smoking cessation aids (such as patches or gums) for 6 weeks before and after surgery. This is critical: smokers who undergo facial plastic surgery can have significant wound complications.
You should discuss with Dr. Nagarkar which medications and supplements you need to stop taking before surgery, and which ones you can continue. In general, blood-thinning medications such as Aspirin, Warfarin, Coumadin, Plavix, or Xarelto must be stopped for a few weeks before surgery. It is very important to provide complete information to prevent any post-operative problems. You will get detailed written instructions for pre- and post-operative care. In addition, you will receive any postoperative prescriptions you might need so that you can have them filled by your pharmacy in advance.
What to expect on the day of surgery:
It is rare that a brow lift is performed without another accompanying procedure, such as a facelift or eyelid surgery. A brow lift adds around 1 hour to any procedure with which it is combined. You should plan on having nothing to eat or drink after midnight the night before surgery. Generally, you will be able to go home immediately after surgery unless you had a face lift or other major procedure performed at the same time. You will need to have someone drive you to and from the surgery, and to help around the house for a few days while you get your energy back.
What to expect after surgery:
Results
Your surgery is designed and performed to achieve the best possible result and as close to 100% symmetry as possible on the operating table. In the first 48 hours after surgery, some swelling occurs, and this is often asymmetric in nature. Swelling will resolve slowly over the course of several weeks. The anesthetic medicines used in surgery can cause your brows to be droopy for several days after surgery – this is temporary. In addition, you may have some numbness of the scalp around the incisions, which can take several months to resolve.
The first few days
It is very important for the first several days after surgery that you keep your head elevated to prevent swelling. You should avoid anything that causes your heart rate to become elevated or your blood pressure to increase – so no strenuous activity. This is important, as an increased heart rate or blood pressure increases the risk of bleeding. Dr. Nagarkar will call you the day after you go home to check in with you and to answer any questions you might have.
Pain
Narcotic pain medications are usually needed only for a day or so, and often not needed at all. Anti-inflammatory over the counter medications like Tylenol are generally adequate. You should not use blood-thinning medications like Aspirin or Ibuprofen for pain, as these increase the risk of bleeding.
Incision care
Your incisions will be closed with internal dissolving sutures. You can start showering two days after surgery. You should avoid baths, swimming, jacuzzis, etc. for 3 weeks after surgery. It is critical that you protect your incisions from sun exposure as they are very sensitive to sunlight for the first six months of the healing process.
Drains
Unless you had a face lift at the same time, you should not require drains.
Diet
You can return to your regular diet after surgery, but for the first day or two, stick with lighter meals. Anesthesia can sometimes make your digestive system a bit sensitive, and having a double cheeseburger the evening after surgery is not recommended. It is very important to refrain from high-sodium foods because these will increase swelling and undo some of the improvement made by surgery.
Work
Your swelling will be mostly resolved by about 2 weeks after surgery. You will be also able to wear makeup around the same time.
Activities
You will be able to go back to non-strenuous activities such as walking, using a computer, writing, and so on, immediately after surgery.
Exercise
Aerobic exercise such as yoga, running, cycling, barre, etc., must be stopped for 3 weeks to allow the skin to heal and prevent bleeding complications. You should not lift anything over 10 lbs for the first 3 weeks.
Driving
You can resume driving once you are no longer taking narcotic medications, and when you feel that you are in full control of your car. This often takes a week or two.
Follow-up visits
You will see Dr. Nagarkar in the office usually around 7 days after surgery to examine the incisions, and ensure that you are healing appropriately. We will see you again at the 2-3 week mark for a brief checkup, and then again around 3 months, 6 months and 1 year after surgery. Keep in mind that if you had a facelift or eyelid surgery performed at the same time, you may have a different schedule of appointments.
To meet Dr. Nagarkar in person, schedule your consultation or call us.