Surgery Instructions – Brow/Forehead Lift

Download the Brow/Forehead Lift Instructions

BLEPHAROPLASTY/BROW OR FOREHEAD LIFT

MEMORIZE THIS PAPER PRIOR TO SURGERY

WHAT TO EXPECT FROM SURGERY TO IMPROVE THE EYELIDS AND FOREHEAD

Wrinkled, sagging upper and lower eyelids, drooping brows, and a wrinkled forehead are often interrelated problems. Dr. Toledo will advise whether correction can best be achieved by a blepharoplasty (eyelid surgery), a forehead lift, or by a direct brow lift, or a combination of the above.

EYELID SURGERY

Wrinkles and pouches beneath the eyes and sagging upper lids are reasons to consider eyelid surgery. In this procedure, excess skin and fat are removed, and stretched muscles are tightened. The results are smooth, sculpted creases on the upper lids, and elimination of most of the wrinkles and pouches beneath the eyes. The scars on the upper lids are in the eyelid crease. In both cases, the scars are barely visible. Not all patients require correction of both the upper and lower lids. Often one or the other is sufficient to obtain the desired results. Patients who undergo eyelid surgery find that their eyes seem larger and more attractive, and their face immediately has a brighter, more alert, and more youthful appearance.

FOREHEAD AND BROWLIFTS

A forehead, or brow lift, is often performed in conjunction with eyelid surgery. It should be considered when there are deep forehead wrinkles, frown lines between the eyes, lines over the nose, or wrinkled, sagging upper lids caused by drooping eyebrows.

If a patient has only eyelid surgery but leaves the other problems uncorrected, the result may not be ideal. Sometimes simply raising the eyebrows will be enough, and an eyelid procedure will not be needed.

Dr. Toledo will help you determine the procedure, or combination of procedures, that is appropriate for you.

THE PREOPERATIVE VISIT

The visit will be scheduled approximately two weeks before surgery. It will give you an opportunity to ask questions you might not have previously asked. We will review your medical history, give you a preoperative examination, arrange for laboratory tests, and discuss what to expect during surgery. If you are over forty years of age or have a history of heart abnormalities, we will arrange for an electrocardiogram. We will also take preoperative photographs, which become a permanent part of your medical record and remain strictly confidential. Your operative consent will be read and signed, preoperative instructions reviewed, and prescriptions will be given you at this visit. Your fee will be due at this time.

Arrangements to facilitate overnight or postoperative care will be made to your individual needs. Facility and anesthesia charges are separate from the surgeon’s fee.

WHAT TO EXPECT DURING SURGERY

Eyelid, forehead, or brow surgery is usually performed at the Highland Park Plastic Surgery Center on an outpatient basis under general or twilight sleep sedation anesthesia. Whichever anesthesia is chosen, you will be made comfortable and unaware throughout the procedure.

Before surgery begins, you will be asked to change into a surgical gown and will be taken into a private operating room. An intravenous line will be inserted into a vein in your arm. This will make it possible to administer fluids and to deliver the necessary medications to make you comfortable. Monitoring devices will be connected to you to assure your safety.

Dr. Toledo will talk with you and use a surgical marking pen to draw lines on your face. These will guide him during the operation. For eyelid surgery, an elliptical incision is made in the upper lid in the natural crease of the lid. Excess skin, muscle, and fat are removed, and the skin is sutured. An incision is then made on the lower lid, just beneath the lashes. This incision extends slightly beyond the outside corner of the eye.

Extra skin and fat are removed, sagging muscles are tightened, and the incision is sutured. If the incision is on the inside of the lid, fat, but no skin, is removed.

For a forehead lift, the incision is generally made across the scalp, just behind or at the edge of the hairline. The skin of the forehead is loosened down to the brows, the necessary muscles are cut and the skin is pulled upward. The incision, which is concealed by the hair, is closed with surgical clips, and a drain is placed. For persons with a high forehead, this incision would not be satisfactory, since it would make the forehead even higher. In such cases the incision is generally made at the hairline. There are instances when a supraorbital brow lift, instead of a forehead lift, will be recommended. In this procedure, the incision is made just above the eyebrows to raise them.

Eyelid, forehead, or brow lift surgery usually takes one and a half to two hours. If performed in conjunction with other procedures, surgery will naturally take longer.

WHAT HAPPENS AFTER SURGERY

You will be transferred to a recovery room adjacent to the surgical suite, where you will be continuously monitored as you recuperate from the effects of the surgery and anesthetic. You will be allowed to go home after a recovery period of one to two hours. You should feel fine, although it is not unusual to expect some minor discomfort.

If you have a forehead lift, you will have a bandage around your forehead and scalp. If you have eyelid surgery, you will not have any bandages, just antibiotic ointment for the eyes. Cold compresses can be applied to minimize swelling.

You must arrange for a responsible person to spend the first night and the next day with you. We will give them instructions for your care before you leave. Have them read this paper prior to surgery. This is absolutely necessary as you will not be able to care for yourself immediately following surgery. They will be required to wake you periodically throughout the first night.

NOTE: If you live out of town, you must make arrangements to stay within a thirty- minute drive of the center for the first 24 hours after surgery.

Because everyone is different, it is impossible to write post op instructions that apply equally to everyone. For example, some patients can have sedation vs. general anesthesia or outpatient vs. inpatient surgery. Some patients have only a single procedure and others may have multiple surgeries in a single setting. Use these instructions as a general guideline, but don’t panic if we vary on some issues.

Preopertaive Guidelines

Bathe your entire body with CLn body wash the 2 nights prior to surgery and again the morning of surgery. CLn body wash is an anti-bacterial, antiseptic liquid soap. Sleep on clean sheets the night before surgery and wear clean clothes to your surgery.

Medications: Take the medications we’ve prescribed according to the instructions on the bottle. You may feel a little drowsy, so have someone help you. If you need a refill, call the office and give us the telephone of your drugstore or pharmacy. Do not take aspirin or ibuprofen for four weeks before or two weeks after the surgery.

TED Hose: The Hose we instructed you to buy and wear is for the prevention of

deep venous thrombosis (blood clots). Deep venous thrombosis affects mainly the veins in the lower leg and the thigh. This clot may interfere with circulation of the area, and it may break off and travel through the blood stream. This clot can then lodge in the brain, lungs, heart, or other areas, causing severe damage to that organ or even death. Any surgical procedure that will inhibit your activity post operatively there is a risk of blood clots. You will be required to wear your TED Hose during surgery and keep them on for 2 weeks after.

Caffeine– Excessive use of products with caffeine such as coffee, tea, or soft drinks, especially Diet Coke, can have similar effects as nicotine. STOP ALL CAFFEINE PRODUCTS 2 WEEKS BEFORE AND AFTER SURGERY.

Smoking– Smoking or nicotine use (chewing tobacco, nicotine gum, snuff) can have a severe detrimental effect on wound healing. The nicotine decreases the vital blood supply to the skin and can cause poor healing or even skin death. STOP ALL NICOTINE PRODUCTS 2 MONTHS BEFORE AND AFTER SURGERY

Hormone replacement therapy and birth control pills increase the incidence of blood clots. STOP 2 WEEKS BEFORE AND AFTER SURGERY.

Postoperative Guidelines

You should expect:

  • Moderate swelling, bruising, and bloodshot eyes which may last for one to two weeks.
  • Drainage or crusting of your eyelids. This is not an infection. Simply draw it away with a Q-Tip dipped in hydrogen peroxide. If your eyelashes are stuck together, use the same technique to tease them apart.
  • A sensation of tightness, itching, and occasionally tearing will subside over several weeks. If you have had a forehead lift, there may be a sensation of tightness in the forehead, which subsides in several weeks.

Call: (214) 363-4444 if you have:

  • Severe pain which doesn’t respond to medication.
  • Significant swelling, and/or unrelenting pain which occurs more on one side than the other.
  • Significant changes in vision, (mild blurring is normal).
  • Shortness of breath or labored breathing can be a sign of a blood clot in your lungs.
  • Any other problems or questions not answered on this sheet.

Activity: You should “take it easy” the day of your operation and the following days. By keeping your head elevated above your heart, swelling can be minimized. Because of your medications, you may need assistance getting to and from the bathroom for the first day.

Eye ointment or drops: After your blepharoplasty, you will use Maxitrol eye ointment in your eyes and on suture lines both for lubrication and prevention of infection. Only apply the ointment on the suture line for the first 24 hours. Keep applying the ointment in your eyes for at least two weeks. After two to three days, or when you run out of Maxitrol switch to Refresh PM ointment, Genteal, or Bauch & Lomb ointment at night and Refresh drops during the day. These medications are available over the counter. Depending on many factors such as the extent of your surgery, history of dry eyes or previous surgeries, you may need the assistance of these lubricants for quite some time.

Pain: Most patients feel that the discomfort from the surgery is minimal. The greatest period of discomfort usually lasts about 24 to 48 hours. Thereafter, you should have less discomfort and less need for medication. Occasionally it lasts a little longer, as different people have different pain tolerances.

Alcohol: Do not drink alcohol for five days after surgery or when you are taking pain medication.

Diet: Start with liquids the first few hours and then progress to your regular diet as you desire.

Hair: You may wash your hair forty-eight hours after the drains are removed. You may blow dry your hair with a warm hand dryer, or sit under a cool dryer, but do not use a hot dryer, electrical rollers, or curling irons for three weeks following a forehead lift.

Compresses and ice packs: Apply cold water compresses to your eyes for

24 hours after surgery and then intermittently. This will decrease discomfort, swelling, and bruising. Our staff will explain how to make simple, effective ice packs.

Reading and television: You may read and watch television at any time, but you may have blurred vision for a few days after surgery. This is normal and probably a result of the ointment.

Eyelid makeup: You will be instructed when you can resume the application of makeup.

This is usually about 7-10 days after surgery (blepharoplasty only).

Contact lenses: You may wear your contacts two weeks after eyelid surgery.

Occasionally, it will take longer until they fit properly. If after 2 weeks your eyes feel dry, you may have to delay the use of contacts.

Sun: Do not sit in the sun at all for three weeks after surgery. If the incisions are exposed, apply sunscreen for six months and wear sunglasses.

Sports: Strenuous sports such as tennis, swimming, jogging, aerobics, or bicycling may be resumed after three weeks. Refrain from any activity which significantly raises your body temperature, blood pressure, or heart rate for three weeks after surgery.

Work: Depending on the kind of work you do, you may return to your job as soon as you are comfortable , usually in about 3 o 5 days.

Driving: You may feel well enough to drive 2 to 3 days after surgery, but not with antibiotic ointment or any lubricants in your eyes which can blur your vision. Never drive under the influence of pain medications or sedatives.

Postoperative visits: The day after surgery, you may be seen at our center, and you will be examined at that time. Sutures will be removed five to six days after surgery. This does not hurt. The forehead lift surgical clips behind the hairline will be removed about 10 – 14 days after surgery. Subsequent visits will be determined by your progress.

You will feel more comfortable using the private postoperative waiting room for your initial postoperative visits. Park at the handicap slot in front. Press the doorbell and we’ll open the door from the inside.

Please feel free to call us at any time during your healing period. THE OUTCOME OF YOUR SURGERY IS IN YOUR HANDS AS WELL AS THE DOCTOR’S. IT IS YOUR RESPONSIBILITY TO FOLLOW ALL INSTRUCTIONS GIVEN TO YOU.

Possible Problems and Complications

No surgical procedure is without risk. Most complications associated with eyelid and forehead surgery, however, are minor. Here are some possible problems:

Collection of blood under the skin (hematoma). This can be removed. Temporary crusting which forms over the incisions.

Loss of sensation in the scalp (forehead lifts). Numbness behind the scalp incision may last six months or more, but usually returns.

Soreness and itching around the incisions. If these sensations occur, they will gradually disappear.

Depression. With aesthetic surgery, as with other surgical procedures, this sometimes occurs postoperatively. This is generally attributed to the normal response of the body to surgery and anesthesia.

Dryness and irritation of the eyes. This is usually temporary and relieved by artificial tears, ointment, or drops.

Asymmetry. No patient is identical from side to side. Small differences exist in every patient. In the occasional patient with a major difference, this can usually be improved with a secondary procedure.

Inability to completely close your eyelids usually temporary.

Potential but unlikely complications: Infection:

Poor healing of the skin, especially in smokers. Loss of small areas of skin (necrosis).

Hypertrophic or keloid scarring. If this happens, it may be treated with cortisone injections, tape, or scar revision.

Hair loss around the incision after forehead lift. If this occurs, the hair generally grows back in a few months, but may be permanent and may require revision.

Pulling down the margin of the lower eyelid. This is usually temporary, and gradually improves as the muscle regains its strength in the first few weeks. Complications of a severe nature, which could be life threatening, or cause loss of vision.

Deep venous thrombosis (blood clots) affects mainly the veins in the lower leg and the thigh. This clot may interfere with circulation of the area, and it may break off and travel through the blood stream. This clot can then lodge in the brain, lungs, heart, or other area, causing severe damage to that organ or even

death. This is the reasons we have you stop hormones, wear TED hose, and walk every 3 hours the night of surgery.

Infection Alert

There is evidence of an increased incidence of MRSA (methicillin-resistant Staphylococcus aureus) and other antibiotic resistant bacteria in our community. In the past, these resistant bacteria were typically found only in hospitals, but they are now found everywhere. Frequently people can be a carrier of the bacteria without their knowledge. An infection with this bacteria can cause severe damage to the skin and even death. We are diligent in cleaning and sterilizing our facility and try to limit the exposure of outside bacteria from patients into our surgery center. We therefore have implemented the following hygiene steps to help prevent the contamination of our facility and therefore decrease your post operative infection risk.

Bathe your entire body with CLn body wash the 2 nights prior to surgery and again the morning of surgery. CLn body wash is an anti-bacterial, antiseptic liquid soap. Sleep on clean sheets the night before surgery and wear clean clothes to your surgery.

YOU MUST ENTER INTO YOUR SURGERY FULLY UNDERSTANDING NOT ONLY THE BENEFITS, BUT ALSO THE POSSIBLE PROBLEMS. ON OCCASION, A MINOR REVISION MAY BE NECESSARY TO ENHANCE THE FINAL RESULTS.

WHAT YOU WILL SEE IN THE MIRROR

Your skin will be tighter. You may look younger and more alert. Any swelling or bruising around the eyes should disappear within two weeks after surgery. Initially your brows and the outer corners of your eyelids maybe a little higher than you wish.

The skin will relax within a few weeks and the brows will settle.

Surgical scars will be permanent, but will fade in time. Every effort is made to conceal scars and make them inconspicuous. For most of our patients, the results of eyelid or forehead surgery are so favorable that the scars become a minimal consideration.

The instructions above are general and some portions may not apply to all patients. Changes in the instructions depend on your medical history, number and type of procedures and type of anesthesia.