Endoscopic Brow Lift Pre-Op, Operation & Post-Op Procedures

  1. Do not take aspirin products, non-steroidal anti inflammatory drugs such as Advil, Ibuprophen, Motrin, Aleve and other prescription drugs, multi-vitamins, vitamin E, anti-aging medications, herbal pills, or products containing these drugs for two weeks prior to surgery and for two weeks following surgery. You should take blood pressure medication in the morning of surgery with sips of water. All other medications (cholesterol, hormones, diabetes etc.) can be skipped.
  2. Do not eat or drink anything from midnight on the day of the surgery for all anesthesia procedures (no coffee, chewing gum, saltines, etc.).
  3. Wear clothing that has a button or zipper front and avoid clothing that pulls over the head.
  4. Do not wear makeup or contact lenses.
  5. Be sure to have a family member or friend drive you home after the surgery and stay with you for the remainder of the day. If you have sedation or general anesthesia, you will not be allowed to leave alone. You must have someone accompany you. A taxi cab driver is not allowed to pick you up, unless you are accompanied by a relative/friend. We will provide you with limousine information, should you require a driver.
  6. Schedule a post-operation follow-up appointment.
  7. Fill prescriptions Dr. Byun has given to you prior to surgery. Most patients will receive IV Antibiotics during surgery. Prescription for pain medications can be used only as needed should pain increase after surgery. Tigan (big pink pill) is a rectal suppository. Use this only in the case of severe nausea.
  8. Buy a reusable ice pack from your local pharmacy (i.e. Walgreens) and a box of clean gauze. You will use them for eye and face areas. The first 48 hours makes the most difference.
  9. If you are a smoker, stop smoking two weeks prior to surgery and two weeks following surgery. Do not wear a nicotine patch or chew nicotine gum because they constrict the blood vessels and deliver less amount of oxygen to the surgery areas.
  10. If you consume alcohol, and are a “social drinker”, meaning you allow yourself one or two glasses of wine, or an occasional beer, on one or two occasions weekly, you need to stop any alcohol intake, 48 hours prior to surgery.

    If you are inclined to have more than “the occasional drink”, meaning your body is conditioned to alcohol intake on a daily basis, or five times, or more, weekly, you need to stop any alcohol consumption 5 days prior to surgery.

    You will be receiving a pre-op phone call the day prior to surgery to give you any instructions, additional information, or answer any questions you may have with regard to your scheduled procedure.

We have provided a sample copy of an Operative Report. The procedure is subject to change per the patients needs.

Endoscopic Brow Lift

PREOPERATIVE DIAGNOSIS:
1. Endoscopic browlift, bilateral
2. Upper lid excess skin, bilateral

POSTOPERATIVE DIAGNOSIS:
1. Endoscopic browlift, bilateral
2. Upper lid excess skin, bilateral

OPERATION:
1. Endoscopic browlift, bilateral
2. Upper lid excess skin, bilateral

ANESTHESIA: General

OPERATIVE PROCEDURE:
After induction of general anesthesia in a supine position, the patient was prepped and draped in the usual sterile fashion. 3 mm of upper lid was marked, and this was resected after injecting that area with 3 ml of 1% Lidocaine with epinephrine. A strip of orbicularis was taken out. The medial fat pad was taken out because she had a bulging of the medial fat pad only. The left side of the upper lid was also performed by resecting 3 mm of skin, and the strip of orbicularis was taken out. The medial fat pocket was explored, and a small amount of fatty tissue was excised. Good hemostasis obtained. The skin was closed using a 6-0 Prolene. Next, four incisions were made along the hairline in a routine way. Subperiosteal dissection was undertaken with Ramirez dissector with the endoscope. Supraorbital nerves were identified and preserved throughout the case. The periosteum along the orbital rim was released, and the forehead was advanced. A small amount of corrugators was resected. Good hemostasis was obtained. The advancement forehead flap was anchored using 3-0 Vicryls to the temporalis fascia bilaterally and the subgaleal along the top of the horehead. The skin was closed using 3-0 chromic. The patient tolerated the procedure well. A bulky dressing was applied. She was extubated and transferred to the recovery room in a good standing.

BROWLIFT / FACELIFT / NECK LIFT

You will have a bulky bandage over and around your head immediately after surgery. Leave this in place for 48 hours. After the 48 hours follow the instructions about showering and incision care, found on the first page of this packet. Cleanse any uncovered incisions 3-4 times a day using clean gauze soaked in saline water (found at your local pharmacy). Be sure to tilt your head back while shampooing and never forward. Keep bunny wrapped Ace bandage applied at all times for the first 72 hours. Remove this wrap only before showering or cleaning incisions and replace afterwards. After 72 hours you can switch off, two hours on and then two hours off. Dr. Byun will direct you on continued use at your follow-up appointment. Also continue to apply light Bacitracin, if needed, to incisions (located on the front and back of ear) for one week or until you see Dr. Byun. It is advisable to sleep with two or three pillows for at least 10 days. You can sleep on your side, as long as it does not cause pain. The head is to be raised 30 degrees for two to three days. We recommend that you sleep on your back.

Some temporary effects of surgery may be: headaches, tightness in the scalp area, a small lump behind the ear, a lump along hairline, bruising, swelling, blurry eyes, dizziness, clogged ears, shooting nerve sensations and numbness. These are all normal and a part of recovery. The forehead does not usually bruise, but it is possible to get black eyes from this procedure. Three days following surgery you can apply makeup on surgial site to disguise bruising. For the first two weeks, avoid any clothing that pulls over your head. In addition, you cannot wear earrings for one month. If you color perm your hair, be sure to do so BEFORE the surgery. No chemicals should applied for six weeks following surgery.

*In most cases the ace bandage is applied in a “bunny wrap” form, tied around the part of the neck under the jaw line and tied at the top of the head resembling floppy bunny ears. Re-apply this “bunny wrap” as the instructions pertaining to your surgery tell you. Do not tie it too loose or too tight. Pressure should have a gentle firmness in order to be effective.

  1. MEDICATIONS
    Use the pain pills and anti-nausea we provided, as needed. You can skip if you don’t need them. If you were prescribed an antibiotic, start taking this immediately following surgery and continue until bottle is finished. Dr. Byun will usually give you a one week course. Discontinued use could make you vulnerable to infection. Do not take blood thinners, aspirin, ibuprofen, multi-vitamins, vitamin E, anti-aging medications, herbal pills, and products containing these drugs for two weeks prior to surgery and for two weeks following surgery since they increase bleeding. Continue taking any other pills for blood pressure, cholesterol, birth control and hormone pills as part of your regular routine.
  2. BANDAGES
    Leave all external bandages on for 48 hours following surgery. The term external bandages refer to bandages that are not directly applied to the skin then reapply them as instructed per surgery.
  3. SWELLING
    Post Operative swelling is normal and peaks about 48-72 hours after the surgery. The majority of the swelling will go down within the first two weeks. Swelling is a part of the healing process, so it is normal for the surgical areas to be swollen for a few months after the procedure as the body heals. You can apply re-useable ice packs to the surgical areas for the first 24-48 hours to help reduce swelling in these areas.
  4. BLEEDING
    Small amount of bleeding from incisions is part of the healing process and is normal. Expect bleeding from the incisions 24-48 hours after the procedure. If bleeding continues after this 48-hour period, apply gentle pressure to the area using clean gauze and call our office.
  5. SHOWER
    You must shower 48 hours following surgery. At this time you may also remove external bandages (ace wrap, epi-foam, and gauze) as directed by the instructions below pertaining to your particular procedure. BAndages/tape applied directly to the skin, if any, especially those covering incisionsmust not be removed. At this time it is also important to allow soapy water and shampoo to run gently through the incision areas. Baby shampoo is recommended as regular shampoo may sting your incisions. Following your shower, re-apply clean/laundered ace wraps, epi-foam, compression garments, and binders as necessary depending on your particular procedure. Fresh gauze can be placed on incision sites if they are irritated by wraps, foam or garments. For patients who have undergone a procedure to the face: when applying shampoo or conditioner be mindful of the incisions along the hairline. Massage the scalp gently taking extra care to not irritate incisions. Also try to avoid snagging suture incisions with a comb or brush.
  6. EXERCISE
    An increased heart rate and blood pressure increases swelling and compromises the healing process, so relax and take it east for the first two weeks following surgery. It is a MUST that you consult Dr. Byun before returning to regular physical activities. With each follow-up as the weeks go by, Dr. Byun will inform you on which activities are suitable for you at that time. Generally however, for the first two weeks light walking and movement is acceptable, while bending forward (as that increases blood pressure in the head and may cause bleeding), stretching the surgery area, and any activities that will raise your heart rate should be avoided.
  7. SLEEPING
    Cover your pillow with an old towel or pillowcase as there will be dripping of blood from the incision in the first 24-48 hours after surgery. This is completely normal. For two weeks, sleep using two pillows to elevate your head, neck and shoulders for face related procedures. Should you have any sleeping difficulty, Tylenol PM is the recommended sleep aid. If the problem still exists, we advise that you call our office for a prescriptive drug, after speaking with Dr. Byun.
  8. DRIVING
    Try not to drive for one week following surgery. If you must drive however, you may not while taking pain medications. Remember, your safety comes first.
  9. SMOKING/ALCOHOL
    If you smoke, do not smoke for two weeks after surgery. Do not wear a Nicotine Patch or chew Nicotine Gum as this constricts your blood vessels and inhibits healing. Do not consume alcohol for at least ten days after surgery as this also raises blood pressure and causes late bleeding. If this will be a problem Dr. Byun can prescribe a medication to help you quit smoking prior to your procedure.
  10. NAUSEA/PAIN
    Nausea is a common side effect. It is recommended by Dr. Byun to take Zofran, which was prescribed to you, as soon as you arrive home and one pill before you go to bed. Along with anesthesia, the pain medication may cause nausea. Therefore, you should stop or decrease the amount of pain medication intake. In order to decrease the nausea created by the pain medication, make sure to take it after meals.