Dr. Sasaki will direct his attention first to your drooping brow complex that gives the impression of a tired, angry, or sad look. In some patients, a significant lowering of the brow contributes to excess skin to the upper eyelids. Dr. Sasaki will demonstrate the natural outcome of an endoscopic brow lift that not only brightens your appearance, but also corrects some of the extra folds of skin within your upper eyelids. If too much skin is present within your upper eyelids, then there may be the need to combine an endoscopic brow procedure with a more conservative upper lid blepharoplasty to obtain the desired result. If your brow and upper eyelid findings are normal for your age or are of minimal concern to you, then Dr. Sasaki will concentrate on your lower lid, face and neck areas.
The endoscopic brow lift represents a minimally-invasive technique to weaken a number of interbrow depressor muscles, to elevate selectively the inner and central brow, to smooth out the horizontal forehead wrinkles lines, and to reposition the outside tail of the brow, thereby clearing the hooded tissue above the lash line. After an appropriate and natural lifting of the brow complex, there will be a simultaneous reduction of primary upper lid skin. In some cases, the amount of upper lid skin relocation will be sufficient to cancel out any skin procedure to the upper lid. In other circumstances, a simultaneous conservative removal of upper lid skin may be advised. A major difference and advantage of this contemporary approach (that distinguishes it from the long-established coronal forehead lift) is the use of five small hidden incisions within the hairline of the scalp. Smaller inconspicuous incisions produce less visible scars and reduce the chance for hair loss and minimize nerve injuries. A tiny camera and long narrow instruments are passed through these access openings to release completely structures that prevent brow elevation. The elevated brow complex is then anchored by absorbing sutures to its new raised, natural and aesthetically pleasing position. Because there is no skin removal after an endoscopic procedure, the frontal hairline remains near its original location, surgical hair loss is minimized, and the chance of a surprised look is significantly reduced.
An endoscopic brow lift may take up to several hours to perform, preferably under general anesthesia, at the hospital. The selected anesthesiologist, with whom Dr. Sasaki regularly works, will meet you in the pre-operative area to answer your questions and to review the details of your anesthesia experience. After surgery, you may be discharged or choose to stay overnight at the hospital. Minimal swelling and bruising are expected because of the use of a drainage tube that is removed the day after surgery. Since there are no surgical dressings, you may shower and shampoo your hair any time you feel the need. The absorbing sutures, that approximate the skin incisions, are trimmed two weeks after surgery. You may be up and about in a few days, but plan to give yourself about a week to recover. Dr. Sasaki will advise you when you can resume strenuous activity between three and six weeks after your surgery.
Dr. Sasaki may suggest a less lengthy and extensive procedure, such a lateral brow lift, rather than an endoscopic forehead and periorbital lift in selected patients with lesser degrees of lateral brow descension. Under local anesthesia in the office, a variable ellipse of skin is removed at the temporal hairline after releasing tissues down to the tail of the brow. Suture suspensions from the brow to the hairline incision stabilize the elevated brow. The limited hairline incision is approximated with absorbing sutures and heals with a minimal and hidden scar.
Dr. Sasaki may indicate a non-invasive procedure, such as Ulthera, that can successfully tighten and lift the lateral brow in a predictable manner to improve the overhanging hooding tissue. This treatment delivers a number of thermal coagulation points at deeper (temporoparietalis fascia) and superficial (reticular dermis) levels without topical anesthetic gels. Such a limited procedure may take less than ½ hour to complete and results in no skin markings and downtime. Natural clinical lifting is usually observed in eight of ten patients by three months and can persist up to 1-1½ years. This revolutionary procedure may be repeated as necessary to maintain a rejuvenated appearance. Please click Ulthera for more information.
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