Your face should reflect your inner beauty at any age. Dr deRamon helps patients look younger, more rested and more vital.

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Face

Brow Lift - Forehead Lift

Our foreheads and brows show a great deal of expression and as we age, lines and wrinkles, sagging skin and low brows may affect appearance. Patients may experience an angry or tired appearance or look as if they are scowling. In some cases, these lines or furrows become permanent and can only be reduced through a brow lift procedure.

 

A brow lift corrects low positioned brows, smoothes furrows and can even raise the eyelid skin to a more attractive position. Overall, a more youthful, awake and relaxed appearance can be achieved.

 

There are many things to consider prior to having a brow lift.

 

Dr. de Ramon performs most brow lifts endoscopically. This requires small skin incisions behind the hair line. Tissues are released with the use of the endoscope, elevated, and held in position with internal sutures until healing is complete. In some cases, a brow lift is done in conjunction with eyelid surgery or a facelift. Other non-surgical options may compliment a brow lift such as Botox®, Restylane or laser treatments.

 

During the consultation, Dr. de Ramon reviews your medical history, discusses your concerns and goals and does physical exam. There is opportunity for questions and an explanation of the procedure(s). A second consult is recommended for final questions and to develop a surgical plan. Insurance does not usually cover brow lift since it is considered a cosmetic procedure. Patients should expect to spend 7-10 days off work, have swelling and bruising for 2 weeks and expect full recovery in about 4-6 weeks.

 

Our other face plastic surgery options:

 

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If Your Doctor Has Recommended Endoscopy...
Endoscopy is a surgical technique that involves the use of an endoscope, a special viewing instrument that allows a surgeon to see images of the body's internal structures through very small incisions.

 

Endoscopic surgery has been used for decades in a number of different procedures, including gallbladder removal, tubal ligation and knee surgery. However, in the world of plastic surgery, endoscopic instruments have recently been introduced. Plastic surgeons believe the technique holds great promise, but further study is needed to establish its effectiveness, especially over the long-term. As important research continues, endoscopy is being used on a limited basis for both cosmetic and reconstructive procedures.

 

This brochure will give you a basic understanding of endoscopy in plastic surgery — how it's performed, what risks are involved, and the type of surgical training to look for in a surgeon. Please ask your doctor if there is anything you don't understand about the specific procedure you're planning to have.

 

The Endoscope
An endoscope consists of two basic parts: A tubular probe fitted with a tiny camera and bright light, which is inserted through a small incision; and a viewing screen, which magnifies the transmitted images of the body's internal structures. During surgery, the surgeon watches the screen while moving the tube of the endoscope through the surgical area.

 

It's important to understand that the endoscope functions as a viewing device only. To perform the surgery, a separate surgical instrument — such as a scalpel, scissors or forceps — must be inserted through a different point of entry and manipulated within the tissue.

 

Advantages of Endoscopy
All surgery carries risks and every incision leaves a scar. However, with endoscopic surgery, your scars are likely to be hidden, much smaller, and some of the after effects of surgery may be minimized.

 

In a typical endoscopic procedure, only a few small incisions, each less than one inch long, are needed to insert the endoscope probe and other instruments. For some procedures, such as breast augmentation, only two incisions may be necessary. For others, such as a forehead lift, three or more short incisions may be needed. The tiny "eye" of the endoscope's camera allows a surgeon to view the surgical site almost clearly as if the skin were opened from a long incision.

 

Because the incisions are shorter with endoscopy, the risk of sensory loss from nerve damage is decreased. Also, bleeding, bruising and swelling may be significantly reduced. With the endoscopic approach, you may recover more quickly and return to work earlier than if you had undergone open surgery.

 

Endoscopic surgery may also allow you to avoid an overnight hospital stay. Many endoscopic procedures can be performed on an outpatient basis under local anesthesia with sedation. Be sure to discuss this possibility with your doctor.

 

In endoscopic surgery, a probe with a tiny camera transmits images inside the body to a video monitor.

 

Uses in Plastic Surgery
As research continues, it's expected that many new uses for endoscopy will be developed. In the meantime, some plastic surgeons are using the technique on carefully selected patients. Some procedures that may be assisted by endoscopy are:

 

Cosmetic Surgery
Abdominoplasty (tummy tuck) — Endoscopy is sometimes used as an adjunct for selected patients who have lost abdominal muscle tone. Guided by the endoscope, the muscles that run vertically down the length of the abdomen may be tightened through several short incisions. Endoscopy is generally not used in patients who have a significant amount of loose abdominal skin.

 

Breast augmentation — Inserted through a small incision in the underarm or the navel, an endoscope can assist the surgeon in positioning breast implants within the chest wall. Endoscopy also may assist in the correction of capsular contracture (scar tissue that sometimes forms around an implant, causing it to feel firm) and in the evaluation of existing implants.

 

Facelift — Although the traditional facelift operation is still the best choice for most patients — especially those with a significant amount of excess skin — certain selected individuals may benefit from an endoscopically assisted procedure. When an endoscope is used, the customary incision along, or in, the hairline is usually eliminated. Instead, small incisions may be strategically placed in areas where the most correction is needed. If the muscles and skin of the mid-face need to be smoothed and tightened, incisions may be hidden in the lower eyelid and in the upper gumline. To tighten the loose muscles of the neck, incisions may be concealed beneath the chin and behind the ears. The endoscope also may assist in the positioning of cheek and chin implants.

 

Forehead Lift — Of all the cosmetic procedures that use endoscopy, forehead lift is the one which plastic surgeons more commonly perform. Instead of the usual ear-to-ear incision, three or more "puncture-type" incisions are made just at the hairline. The endoscope helps guide the surgeon, who removes the muscles that produce frown lines, and repositions the eyebrows at a higher level.

 

Reconstructive Surgery
Flap surgery — Endoscopy can assist in repairing body parts that are damaged from injury or illness. Often, healthy tissue is "borrowed" from one part of the body to help repair another. Using an endoscope, the tissue or flaps can be removed from the donor site with only two or three small incisions.

 

Placement of Tissue Expanders — Used frequently in reconstructive surgery, tissue expanders are silicone "balloons" that are temporarily implanted to help stretch areas of healthy skin. The newly expanded skin is then used to cover body areas where skin has been lost due to injury (such as a burn) or disease. Using an endoscope, a surgeon can help ensure that a tissue expander is precisely positioned beneath the surface to bring the greatest benefit to the patient.

 

Sinus Surgery — An endoscope can assist a surgeon in pinpointing and correcting sinus-drainage problems. It can also help locate nasal polyps (growths) or other problems within the sinus cavity, and assist in full rhino-septal surgery.

 

Carpal Tunnel Release — After the endoscope is inserted through a small incision in the wrist area, the surgeon locates the median nerve, which runs down the center of the wrist. A separate incision may be made in the palm to insert scissors or scalpel to cut the ligament putting pressure on the nerve.

 

Finding a Well-Trained Surgeon
Because endoscopy is a relatively new technique in plastic surgery, it's extremely important that you select a board-certified plastic surgeon who has adequate training and experience.

 

Many endoscopic procedures do not require a hospital stay and are performed in a surgeon's office or an out-patient surgery center. If you're planning to have out-patient surgery, be sure that the surgeon you've selected has privileges to perform your particular endoscopic procedure at an accredited hospital. This assures you that your surgeon has been evaluated by the hospital's quality-assurance review committee and is generally considered to have the needed training.

 

Be sure to find out if the surgeon's hospital privileges cover both the endoscopic and the open version of the procedure you plan to have, since your doctor may have to switch to a traditional open procedure if a complication occurs during surgery.

 

Keep in mind that many plastic surgeons in practice today received endoscopy training as part of their plastic surgery or general surgery residency training. And all board-certified plastic surgeons are continually being trained in new procedures.

 

Special Consideration and Risks
It's important to keep in mind that the endoscopic approach has only recently been applied to plastic surgery procedures. There are some known risks, which vary in severity depending on the procedure being performed. These include infection, fluid accumulation beneath the skin (which must be drained), blood vessel damage, nerve damage or loss of feeling, internal perforation injury, and skin injury.

 

Keep in mind that if a complication occurs at any time during the operation, your surgeon may have to switch to an open procedure, which will result in a more extensive scar and a longer recovery period. However, to date, such complications are rare — estimated to occur in less that 5 percent of all endoscopy procedures.

 

Deciding if Endoscopic Surgery Is Right for You
Although much is still unknown about endoscopic plastic surgery, you may want to focus on what is known as you make your decision. Considering the following:

 

For decades, endoscopy has been used successfully in orthopedic, urologic and gynecologic procedures. Improved technology now permits endoscopy to be used by plastic surgeons.

 

If performed by an experienced, well-trained plastic surgeon, endoscopic procedures may provide the same results as open-method procedures but with less scarring.

 

In some cases, endoscopic surgery may require less recovery time than is usually required for open procedures.

 

Patients who tend to be the best candidates for cosmetic endoscopic procedures are those who don't have large amounts of loose hanging skin. Patients with loose facial or abdominal skin may benefit from a combination of classic and endoscopic techniques in face or forehead lift, or abdominoplasty.


If You're Considering a Forehead Lift...
A forehead lift or "browlift" is a procedure that restores a more youthful, refreshed look to the area above the eyes. The procedure corrects drooping brows and improves the horizontal lines and furrows that can make a person appear angry, sad or tired.

 

In a forehead lift, the muscles and tissues that cause the furrowing or drooping are removed or altered to smooth the forehead, raise the eyebrows and minimize frown lines. Your surgeon may use the conventional surgical method, in which the incision is hidden just behind the hairline; or it may be performed with the use of an endoscope, a viewing instrument that allows the procedure to be performed with minimal incisions. Both techniques yield similar results — smoother forehead skin and a more animated appearance.

 

If you're considering a forehead lift, this brochure will provide a basic understanding of the procedure — when it can help, how it's performed and what results you can expect. It won't answer all of your questions, since a lot depends on your individual circumstances. Be sure to ask your doctor if there is anything you don't understand about the procedure.

 

The Best Candidates for a Forehead Lift...
A forehead lift is most commonly performed in the 40 to 60 age range to minimize the visible effects of aging. However, it can also help people of any age who have developed furrows or frown lines due to stress or muscle activity. Individuals with inherited conditions, such as a low, heavy brow or furrowed lines above the nose can achieve a more alert and refreshed look with this procedure.

 

Forehead lift is often performed in conjunction with a facelift to provide a smoother overall look to the face. Eyelid surgery (blepharoplasty) may also be performed at the same time as a forehead lift, especially if a patient has significant skin overhang in the upper eyelids. Sometimes, patients who believe they need upper-eyelid surgery find that a forehead lift better meets their surgical goals.

 

Patients who are bald, who have a receding hairline, or who have had previous upper-eyelid surgery may still be good candidates for forehead lift. The surgeon will simply alter the incision location or perform a more conservative operation.

 

Remember, a forehead lift can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them in detail with your doctor.

 

All Surgery Carries Some Uncertainty and Risk
Complications are rare and usually minor when a forehead lift is performed by a qualified plastic surgeon. Yet, the possibility of complications must be considered.

 

In rare cases, the nerves that control eyebrow movement may be injured on one or both sides, resulting in a loss of ability to raise the eyebrows or wrinkle the forehead. Additional surgery may be required to correct the problem.

 

Formation of a broad scar is also a rare complication. This may be treated surgically by removing the wide scar tissue so a new, thinner scar may result. Also, in some patients, hair loss may occur along the scar edges.

 

Loss of sensation along or just beyond the incision line is common, especially with the classic forehead lift procedure. It is usually temporary, but may be permanent in some patients.

 

Infection and bleeding are very rare, but are possibilities.

 

If a complication should occur during an endoscopic forehead lift, your surgeon may have to abandon the endoscopic approach and switch to the conventional, open procedure, which will result in a more extensive scar and a longer recovery period. To date, such complications are rare — estimated at less than 1 percent of all endoscopy procedures.

 

You can reduce your risk of complications by closely following your surgeon's instructions both before and after surgery.

 

Planning Your Surgery
For a better understanding of how a forehead lift might change your appearance, look into a mirror and place the palms of your hands at the outer edges of your eyes, above your eyebrows. Gently draw the skin up to raise the brow and the forehead area. That is approximately what a forehead lift would do for you.

 

If you decide to consult a plastic surgeon, he or she will first evaluate your face, including the skin and underlying bone.

 

During your consultation, the surgeon will discuss your goals for the surgery and ask you about certain medical conditions that could cause problems during or after the procedure, such as uncontrolled high blood pressure, blood-clotting problems, or the tendency to develop large scars. Be sure to tell the surgeon if you have had previous facial surgery, if you smoke, or if you take any drugs or medications - including aspirin or other drugs that affect clotting.

 

If you decide to proceed with a forehead lift, your surgeon will explain the surgical technique, the recommended type of anesthesia, the type of facility where the surgery will be performed, the risks and the costs involved. Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results of surgery.

 

Preparing for Your Surgery
Your surgeon will give you specific instructions to prepare for the procedure, including guidelines on eating and drinking, smoking, and taking and avoiding certain vitamins and medications. Carefully following these instructions will help your surgery and your recovery proceed more smoothly.

 

If your hair is very short, you may wish to let it grow out before surgery, so that it's long enough to hide the scars while they heal.

 

Whether your forehead lift is done in an outpatient facility or in the hospital, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two.

 

Where Your Surgery Will Be Performed
A forehead lift is usually done in a surgeon's office-based facility or an outpatient surgery center. However, it is occasionally done in the hospital.

 

Anesthesia Used for the Procedure
Most forehead lifts are performed under local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and although you may feel some tugging and mild discomfort, your forehead will be insensitive to pain.

 

Some surgeons prefer to use general anesthesia, in which case you'll sleep through the entire operation.

 

The Surgery
Your surgeon will help you decide which surgical approach will best achieve your cosmetic goals: the classic or "open" method, or the endoscopic forehead lift. Make sure you understand the technique that your surgeon recommends and why he or she feels it is best for you.

 

The Classic Forehead Lift
Before the operation begins, your hair will be tied with rubber bands on either side of the incision line. Your head will not be shaved, but hair that is growing directly in front of the incision line may need to be trimmed.

 

For most patients, a coronal incision will be used. It follows a headphone-like pattern, starting at about ear level and running across the top of the forehead and down the other side of the head. The incision is usually made well behind the hairline so that the scar won't be visible.

 

If your hairline is high or receding, the incision may be placed just at the hairline, to avoid adding even more height to the forehead. In patients who are bald or losing hair, a mid-scalp incision that follows the natural pattern of the skull bones is sometimes recommended. By wearing your hair down on your forehead, most such scars become relatively inconspicuous. Special planning is sometimes necessary for concealing the scar in male patients, whose hairstyles often don't lend themselves as well to incision coverage.

 

If you are bald or have thinning hair, your surgeon may recommend a mid-scalp incision so the resulting scar follows the natural junction of two bones in your skull and is less conspicuous.

 

Working through the incision, the skin of the forehead is carefully lifted so that the underlying tissue can be removed and the muscles of the forehead can be altered or released. The eyebrows may also be elevated and excess skin at the incision point will be trimmed away to help create a smoother, more youthful appearance.

 

The incision is then closed with stitches or clips. Your face and hair will be washed to prevent irritation and the rubber bands will be removed from your hair. Although some plastic surgeons do not use any dressings, your doctor may choose to cover the incision with gauze padding and wrap the head in an elastic bandage.

 

The Endoscopic Forehead Lift
Typically, an endoscopic forehead lift requires the same preparation steps as the traditional procedure: the hair is tied back and trimmed behind the hairline where the incisions will be made.

 

However, rather than making one long coronal incision, your surgeon will make three, four or five short scalp incisions, each less than an inch in length. An endoscope, which is a pencil-like camera device connected to a television monitor, is inserted through one of the incisions, allowing the surgeon to have a clear view of the muscles and tissues beneath the skin. Using another instrument inserted through a different incision, the forehead skin is lifted and the muscles and underlying tissues are removed or altered to produce a smoother appearance. The eyebrows may also be lifted and secured into their higher position by sutures beneath the skin's surface or by temporary fixation screws placed behind the hairline.

 

When the lift is complete, the scalp incisions will be closed with stitches or clips and the area will be washed. Gauze and an elastic bandage may also be used, depending on your surgeon's preference.

 

After Your Surgery
The immediate post-operative experience for a patient who has had a classic forehead lift may differ significantly from a patient who had the procedure performed endoscopically.

 

Classic Forehead Lift
Patients may experience some numbness and temporary discomfort around the incision, which can be controlled with prescription medication. Patients who are prone to headaches may be treated with an additional longer-acting local anesthesia during surgery as a preventive measure.

 

You may be told to keep your head elevated for two to three days following surgery to keep the swelling down. Swelling may also affect the cheeks and eyes - however, this should begin to disappear in a week or so.

 

As the nerves heal, numbness on the top of your scalp may be replaced by itching. These sensations may take as long as six months to fully disappear. If bandages were used, they will be removed a day or two after surgery. Most stitches or clips will be removed within two weeks, sometimes in two stages.

 

Some of your hair around the incision may fall out and may temporarily be a bit thinner. Normal growth will usually resume within a few weeks or months. Permanent hair loss is rare.

 

Endoscopic Forehead Lift
Patients may experience some numbness, incision discomfort and mild swelling.

 

Incision site pain is usually minimal, but can be controlled with medication, if necessary. Endoscopic forehead lift patients usually experience less of the itching sensation felt by patients who have had the classic forehead lift.

 

The stitches or staples used to close the incisions are usually removed within a week and the temporary fixation screws within two weeks.

 

Getting Back to Normal

Although you should be up and about in a day or two, plan on taking it easy for at least the first week after surgery. You should be able to shower and shampoo your hair within two days, or as soon as the bandage is removed.

 

Most patients are back to work or school in a week to 10 days. Endoscopic patients may feel ready to return even sooner. Vigorous physical activity should limited for several weeks, including jogging, bending, heavy housework, sex, or any activity that increases your blood pressure. Prolonged exposure to heat or sun should be limited for several months.

 

Most of the visible signs of surgery should fade completely within about three weeks. Minor swelling and bruising can be concealed with special camouflage makeup. You may feel a bit tired and let down at first, but your energy level will increase as you begin to look and feel better.

 

Your New Look
Most patients are pleased with the results of a forehead lift, no matter which surgical method was used. Often, patients don't realize how much their sagging forehead contributed to the signs of aging until they see how much younger and more rested they appear after the lift.

 

Although a forehead lift does not stop the clock, it can minimize the appearance of aging for years. As time passes, you may want to repeat the procedure.