In recent years, the surgical approach to the brow or forehead has been advanced by the endoscope, a special viewing instrument that allows the surgeon to see inside the body through very small incisions. Endoscopy has been used for many years in other medical specialties for knee cartilage repair, gall bladder removal, and “Band-Aid” tubal ligation. When the endoscope is applied to plastic surgery, very small incisions are needed to perform surgeries that in the past were performed through longer skin incisions such as the brow lift. Traditionally, a brow lift was performed through an incision in the scalp that ran from ear-to-ear. This procedure, called the “coronal” approach, is still used occasionally. In most cases, however, this approach can be replaced by the endoscopic brow lift, which is less traumatic and entails a shorter recovery period.
Many people first notice a tired appearance in the region around their eyes as they approach forty. Others may notice that they appear sad or depressed. Still others may notice that they always appear angry or unhappy. This sad, tired or angry appearance may be the consequence of changes in the structures of the brow or forehead. With the passage of time and under the influence of gravity, the eyebrows descend to a slightly lower position over the eyes. This “crowding” of the tissues around the eyes contributes to a sad or tired look. Overactivity of the small muscles between the eyebrows can create vertical frown lines that convey an angry appearance.
PRIOR TO SURGERY
At your initial consultation, Dr. Glassman will ask you to express your concerns about your appearance. Your medical history will be reviewed and a physical examination will be conducted to determine if a surgical procedure is best for you. If you are a good candidate for surgery, Dr. Glassman will explain what can be done to assist you.
Dr. Glassman may request that you visit your private medical doctor for a check-up and for any necessary lab work and x-rays. Precise preoperative instructions are provided, and all necessary prescriptions are given to you in advance of the surgery. All aspirin, aspirin-containing products, and anti-inflammatory products must be stopped at least ten days before and for ten days after surgery. You will be provided with a complete list of which medications to avoid. Tylenol may be taken during this time. Also, you will be given a list of vitamins and homeopathic preparations to take prior to and after the surgery. This is done to promote healing and limit bruising.
In the vast majority of endoscopic brow lifts, general anesthesia is used. However, in some cases, local anesthesia with intravenous sedation may be used. Dr. Glassman and our anesthesiologist will help you make this decision based on what type of anesthesia is best for you.
The endoscopic brow lift is generally performed as an outpatient in a private facility. It may be combined with other procedures, such as cosmetic eyelid surgery and/or a facelift.
After anesthesia is given, four to six small incisions are placed in the scalp a few inches behind the hairline. These incisions measure less than one half inch in length. Your hair will not be shaved for the surgery. It is simply parted to expose the sites for the small incisions.
The endoscope, a small hollow tube equipped with a light and a video camera, is inserted into one of the incisions. Miniaturized special endoscopic instruments are inserted through the other incisions. The desired changes are made while the anatomy of the forehead and the instruments are viewed on a video monitor. The small muscles between the eyebrows that cause frown lines are altered without compromising the expression of the forehead. The eyebrows are carefully elevated and precisely secured at a slightly higher, more youthful position. Care is taken to avoid a “startled” or “surprised” look which is undesirable.
A few stitches are placed in the incisions and a bandage is placed over the forehead and scalp. The operation takes a little over one hour.
THE POST OPERATIVE PERIOD
The first one to two hours after surgery are spent in the recovery room. When you are fully alert, you will be able to return home in the care of a friend or family member. A private nurse can be provided at your request. Some patients chose to spend the first night after surgery in an aftercare facility, where care is provided around the clock by licensed nurses.
The following morning, all bandages are removed in our office. The surgical sites are inspected and cleansed, and a lighter bandage is placed. Instructions are given on how to care for the incisions until the stitches are removed in seven to ten days.
The pain following endoscopic brow lift is described by most patients as mild to moderate. Pain medication is prescribed, although this is usually unnecessary after the first day. Sleeping with your head elevated can significantly reduce any discomfort.
There may be mild bruising and swelling which lasts for approximately one week. This can easily be covered with makeup. Most patients return to work and social activities after one week. Strenuous physical exercise is avoided for two to three weeks following an endoscopic brow lift.
RISKS AND COMPLICATIONS
As with any operation, the endoscopic brow lift has minimal risks and potential complications. However, with highly trained doctors and nurses making up the surgical team, complications are extremely rare. Like all surgery, the risk of bleeding, infection, scarring or an anesthetic problem is present. The risks and complications specific to an endoscopic brow lift, however, are probably less than with the conventional coronal technique. The possibility of hair loss near the incision is significantly reduced with the tiny incisions used in the endoscopic technique. Numbness caused by injury to the sensory nerves is also unlikely. And, injury to the motor nerves that move the forehead is extremely rare with either technique. Rarely, if the surgeon deems it necessary, he must convert the endoscopic approach to the conventional technique during surgery.
The goal and the result of an endoscopic brow surgery are a more well rested and pleasant expression to the upper portion of your face. The improvement is not a transient one and can be expected to last several years. Of course, as you continue to age, accompanied by the pull of gravity, the results will not be permanent. When this occurs, if you chose to have additional brow surgery, it can be performed safely and easily.
ADVANTAGES OF THE ENDOSCOPIC TECHNIQUE
The major advantage of the endoscopic approach over the coronal approach is the markedly smaller incisions. The smaller incisions greatly lessen the possibility of hair loss or numbness. Generally, there is less swelling and less bruising with this technique. Thus, you will be able to resume your every day activities in a significantly shorter period of time.