Industry Associations:
Endoscopic Browlift
By Dr. Mark P. Kohout Published: 11/03/2010
Endoscopic Browlift
If you are considering surgery we want you to be thoroughly informed about this procedure. Reading this information is the first step. However, a personal consultation with your surgeonis the best way to obtain any additional information you need.
An exciting new era in face and browlifting
has evolved in recent years. The development
of modern surgical techniques has seen the
introduction of high tech endoscopic “key hole”
procedures. By using small incisions and utilising a
telescope, browlifts and facelifts can now be done
without scarring on the face.
As we age, the forehead and brows may sag as do
lower facial tissues. Frown lines also appear due
to the action of underlying forehead muscles.
These factors lead to a heavy and tired look to the
forehead and upper eyelids. Browlifting is aimed
at lifting the tissues of the brow and forehead
and smoothing frown lines. This gives a brighter,
younger look not only to the forehead but also the
eyes. Conventional open browlifting has meant
that in the past patients needed to accept a long
scar across the upper forehead hairline or over the
top of the head. Patients were reluctant to accept
these scars and using endoscopic techniques
browlifting has now become a more widely
tolerated procedure. Surgery time is reduced,
there are no scars on the face and post-operative
pain and recovery is dramatically reduced with
patients usually returning to normal activities
within 7-10 days.
Endoscopic browlift is the most common
endoscopic cosmetic procedure performed
around the world today. Through small “keyhole”
incisions behind the forehead hairline, a small
telescope is inserted and used to guide the surgeon
in lifting the tissues of the forehead and brow. At
the same time, the small muscles of the forehead
responsible for causing frown lines are weakened
so that these lines are smoothed or disappear.
In the case of patients seeking eyelid rejuvenation
(blepharoplasty) the effect of the brow on the
upper eyelids needs to be considered. Heavy
or sagging eyebrows may give the appearance
of drooping upper eyelids and tiredness. This
may best be treated by browlift either alone or
in conjunction with upper lid blepharoplasty
rather than by blepharoplasty alone. Patients
report having a brighter, alert and more youthful
appearance.
Endoscopic browlift is usually performed as a
day stay procedure under general anaesthetic or
twilight sedation. Endoscopic browlift can be
combined with facelifting and blepharoplasty.
Are you thinking about a
browlift?
If you are considering surgery, your plastic
surgeon wants you to be thoroughly informed
about this procedure. Reading this information
is the first step. However, a personal consultation
with a qualified plastic surgeon is the best way to
obtain any additional information you need.
What is a browlift?
Browlift is a surgical procedure designed to
elevate the eyebrows. There is a number of
different methods for achieving this. The purpose
of the browlifting is to return a dropped brow to
its original youthful position, rather than higher
than natural height.
Is endoscopic browlift for me?
Any of the following conditions may make you
are a good candidate for surgery:
• your upper eyelids have prominent skin
Hooding
• the eyebrow has dropped to close the
naturally open eye appearance
• your eyes look tired and droopy
Initial consultation
During the initial consultation, you may be asked
to point out exactly what you would like to see
improved. This will help your plastic surgeon to
understand your expectations and determine
whether they can be realistically achieved.
You will be asked about your medical history
including previous operations, past and present
medical conditions and current medications. In
order to provide you with the best information
and safest options, it is important that you give
your surgeon complete information. The medical
conditions that may increase risks of surgery
include high blood pressure, thyroid problems,
diabetes and bleeding problems.
Preoperative photographs may be taken during
your initial consultation or a subsequent visit.
Your surgeon will discuss with you the details
of the operation and the possible risks and
complications associated with the procedure.
Risks and possible complications
of surgery
Fortunately, significant complications from
browlift surgery are infrequent. Every year, many
thousands of operations are performed with
no major problems and good results. However,
everyone considering surgery should be aware of
both the benefits and risks. The subject of risks
and potential complications of surgery is best
discussed on a personal basis between you and
your plastic surgeon.
• Asymmetry. The position of the
eyebrows following surgery may be
slightly different.
• The position of the eyebrow is different
form that which was planned. This may
be a higher or lower position.
• Nerve injury. The two nerves that are
at risk are the supraorbital nerve which
gives you feeling in the forehead and
scalp. Injury to this nerve may produce
numbness in the forehead and scalp,
either temporary or, rarely, permanent.
The other nerve is the nerve that
actually moves the eyebrow upwards.
Injury to this nerve may, paradoxically,
cause eyebrow droop and may lead to
asymmetry.
• Bleeding and bruising around the eyes.
This may cause a frank “black eye”
• Loss of some hair around the incisions.
You can help to minimise certain risks by
following the advice and instructions of your
plastic surgeon, both before and after your
surgery.
Preparation for surgery
The goal of your plastic surgeon and the staff
is to make your surgical experience as easy and
comfortable for you as possible.
Smokers will be asked to stop smoking 3
weeks before surgery. Aspirin and some
anti-inflammatory drugs used for the treatment of
arthritis can cause increased bleeding, so you
should avoid taking these medications for 2 weeks
before surgery. surgery is usually performed on
an outpatient basis. If this is the case, make
certain you have someone drive you home after
surgery and to stay with you at least the first night
following surgery.
The day of surgery
Your surgeon will mark your skin before the
operation and if you have not already done so,
you will need to sign the consent form for your
operation. Your surgery may be performed in a
hospital, or in a day surgery facility depending
on the extent of the operation you need.
Medications are administered for your comfort
during the surgical procedure. During the
anaesthetic, various monitors are used to check
your heart, blood pressure, pulse and the amount
of oxygen circulating in your blood.
Your operation
Because of individual factors, not everyone will
achieve the same results from surgery. Your
plastic surgeon will select the surgical technique
that he or she feels will obtain the best outcome
for you.
The operation takes 1 to 2 hours, depending on
the extent of each case. Isolated Browlift can
be performed as a day procedure although this
is seldom the dace. More commonly, Browlift
is performed as part of upper or total facial
rejuvenation and is partnered with procedures
such as eyelid skin reduction, facelift or laser
resurfacing.
With endoscopic Browlift, four, two-centimetre
incisions above the hairline will be made and
the forehead skin dissected from the underlying
forehead. The forehead skin, including the
eyebrow are repositioned upwards and held in
position with several reabsorbable screws.
These screws will dissolve form under the skin over
12 months. The incisions are then closed with
stitches or surgical clips.
After surgery
When surgery is completed, you will be taken
into a recovery area where you will continue to
be closely monitored.
It is important to realise that the amount of
time it takes for recovery varies greatly among
individuals.
The first evening after surgery, you should rest
quietly with your head elevated. Your surgeon
may instruct you to apply cold compresses to your
eyelids. Remember, you must not take aspirin or
anti-inflammatory medications.
Initially, you may feel a “tight” sensation around
the eyes and some mild discomfort that can be
controlled with oral pain medication such as
Panadol. During the first 48 hours following
surgery, patients experience varying degrees of
swelling and bruising. Some patients find that
mild swelling persists for several weeks, while
others may see swelling resolve in as little as one
week. Bruising typically disappears within seven
to ten days. Within the first week you will be
permitted to use makeup, if desired, to conceal
any discoloration. Stitches along the incisions are
usually removed within a week of surgery.
When can i resume my normal
activities?
Considerable bruising and swelling over the first
week may be encountered. This can be expected
to settle rapidly over the first week and will
usually have completely resolved by the end of
the second week. Generally speaking you will be
confident and happy to engage in social contact
by about the second week following surgery
although this varies with each patient.
Straining, bending and lifting should be avoided
for 2 weeks after surgery. In many instances,
however, you will be able to resume most of your
normal activities in ten days or less.
Results of your surgery
Since the healing process is gradual, you should
expect to wait at least several weeks to get an
accurate picture of the results of your eyelid
surgery. Incisions will fade over a number of
months until they become barely visible.
Maintaining a relationship with
your plastic surgeon
Should there be any questions regarding
Surgery, be sure they are answered in advance.
Well meaning friends are not a good source
of information. Find out everything before
proceeding with the operation - a well informed
patient is a happy one.
After surgery, you will return to your plastic
surgeon’s office for follow-up care at prescribed
intervals, at which time your progress can be
evaluated. Post-operative photographs will form
a part of the evaluation of your result. Once the
immediate postoperative follow-up is complete,
many surgeons encourage their patients to come
back for periodic check-ups to observe and
discuss the long-term results of surgery.
Please remember that the relationship with your
plastic surgeon does not end when you leave
the operating room. If you have questions or
concerns during your recovery, or need additional
information at a later time, you should contact
your surgeon.
