The face can be thought of two layers; the outer skin and the deeper soft tissues,
which include fat and the muscles. In youth the skin has very few lines; the
tissues are firm and smooth. As we grow older the skin loses its elasticity.
Factors that influence the rate and degree of the aging process are genetic, sun
exposure, smoking, alcohol, general systemic illness and weight fluctuation. The
deeper tissues are also affected by aging causing laxity and sagging of the
upper, mid, and lower face. In the forehead the eyebrows sag and as the
muscles contract to re-lift them, deep wrinkles form. In the midface the cheek fat
falls causing loss of the cheekbone highlights and deep nasolabial creases.
Sagging along the border of the jaw causes jowl fullness, and in the neck forms
skin webbing. Fat in this area causes the double chin.

How can this condition be corrected?

To improve upon the skin damage and fine wrinkling the use of creams,
dermabrasion, chemical peels, laser or Visage are required to resurface the skin.
To lift the deeper tissues a "browlift" is required in the forehead region and a
"facelift" or "rhytidectomy" are used to tighten the mid facial and lower neck skin
region. These may be combined with other facial operations such as eyelid
surgery, liposuction, chin or cheek implants, and fat injections.

Will a brow/facelift help everyone?

Brow/facelifts are not effective for correction of generalized fine wrinkling. There
are other procedures for this as previously mentioned. In the past standard lifts
required large skin excisions and were reserved for older patients. With the new
endoscopic techniques the incisions are small and suitable for younger patients.
The chief benefit of the endoscopic browlift is that no strip of scalp is removed
and sensation to the top of the scalp is generally maintained. The frowning
muscles between the eyebrows can be removed and the brows are elevated
through these small incisions. Some frown lines will remain after the surgery
however the forehead will have a softer more youthful appearance. It should be
noted that after a browlift the aging process does continue at the normal rate,
however the procedure could be repeated.

How is a Browlift Performed?

The basic operation is designed to lift the eyebrows back to a more youthful
level, remove the frowning muscles between the brows, and to give the forehead a
more rested look. There are many variations on the basic procedure. Deep plane
brow lifting is a newly developed evolution of the standard brow lift procedures.
This differs from the standard procedures in that the surgery is performed deep
under the facial muscles and the dissection involves less cutting of the sensory
nerves to the forehead. In the pure endoscopic technique five small 1/2-inch
incisions are made in the hairline and a telescope with a TV camera is
introduced under the skin to free up the tissues. The frowning muscles are
removed and the eyebrows and forehead are lifted. This moves back the hairline
slightly in younger patients. In older patients this may not be desirable and a
strip of skin may be removed at the hairline leaving a small scar in this area.
While this procedure only improves the forehead, the facelift procedure is
commonly combined to simultaneously improve the mid and lower face.

What about the scars?

Scar tissue is the normal product of the body's healing process, so surgery is
not possible without scars. The incisions are carefully planned and located so
they lie within the hair in most people or right at the edge of the hairline in those
who desire to have the forehead hairline lowered, making them as inconspicuous
as possible. Because they are small they are also suitable for balding men. You
must follow postoperative activity and wound care instructions to promote
healing. The individual characteristics of natural healing are the main factors in
determining scar appearance.

What are the more common complications?

A browlift is a low risk procedure, but as with any operation, there are certain
potential problems. 

The complications of anaesthesia, whether local (freezing) or general, are part of
the risk of even minor surgery. Although rare, nerve damage can occur which
might cause a varying amount of facial weakness or paralysis of the muscles
that elevate the brow, close the eye or affect the smile. These complications can
be temporary or permanent. If temporary, this can take up to one year to
improve. Asymmetry of the eyebrow (often present preoperatively) may occur. As
in all surgery, complications such as infection or bleeding can occur and require
appropriate treatment including possible surgery. At times fluid or blood may
accumulate in the operative sites which may require aspiration, drainage, or
removal by surgery. This risk increases with high blood pressure or intake of
aspirin and like medications. There may be blistering, crusting, or loss of skin
with delayed healing in areas where the skin has been undercut and pulled
tightly. These risks are increased with smoking. There may be scattered areas of
numbness over the face, forehead, scalp, neck and ears following the surgery,
which may persist for an indefinite period of time. Itching of the scalp is common.

Many patients will notice temporary diffuse thinning of the hair from the swelling
of the scalp. Temporary or permanent hair loss around incisions is uncommon.
Scar tissue forms lumps/irregularities under the skin that resolve over a few
months. Swelling of the eyes can cause "water blister like" appearance
temporarily. Irritation or dryness of the eyes may occur. Ridging of the scalp
skin/or in front of the ear usually smoothes out over time. To have optimal healing
no smoking one month prior to surgery or 3 weeks after surgery is recommended
as well as avoiding use of a nicotine patch or chewing gum during this period.