Brow Lift/Forehead Lift
One of the first signs of facial aging is often descent of the brow which can give the appearance of being angry, sad, stern or tired. This can be seen in patients starting as early as 30. An eyebrow lift is a cosmetic procedure designed to reposition the brow, give the eyes a more open and brighter appearance, and correct the wrinkles on the forehead, upper eyelid, and eyebrow area by lifting the tissue and re-draping the skin. Scars are placed within the hairline so as not to be visible. The procedure is typically accomplished under general anesthesia with the use of an endoscope.
About the Procedure
- Length of Procedure – About 1.5 hours
- Anesthesia – General/outpatient procedure
- Side Effects – Vary depending upon the patient, but generally include swelling, numbness, headaches, and bruising. Patients may experience possible itching and hair loss at the incision sites as the wounds heal – a condition that may last for several months. Patients may also experience a rare condition that causes a change in the hairline.
- Risks – Slight risk of injury to the facial nerve, which could result in a loss of motion, muscle weakness, or asymmetrical appearance. There is a minor risk of infection and a possibility of broad or excessive scarring.
- Recovery – Patients should expect to return to work within 7-10 days.
- Exercise – Patients should abstain from rigorous exercise for the first 2 weeks following the procedure, after which they may return to 1/3 normal intensity, increasing to 2/3 normal intensity at 6 weeks, and a return to full exercise intensity at 8 weeks.
- Fading and Scar Improvement – Depending upon the health of the underlying tissue, the patient should begin to notice a reduction in the appearance of the surgical scar in 6 to 12 months.
- Hair Care – Normal salon treatments, including highlights and coloring, can resume after 4 weeks.
- Bruising – Localized bruising of the area will be noticeable for 2-4 weeks following the procedure.
- Swelling – Moderate to significant swelling of the area should be expected for up to 4 weeks following the initial procedure with a reduction and dissipation over the course of the next 2 to 3 months.
- Recovery – As with most facial cosmetic surgery procedures, the patient can expect to begin noticing improvement within 2 weeks, with a noticeable improvement in appearance at 4 weeks and continued subtle/soft improvements for 6 months.
- Duration of Results – Duration of improvement is dependent upon many factors, but the patient will typically experience an improvement in their appearance for 10 years after the procedure has been completed. This is not a procedure which typically has to be repeated.
- Office Visits – The patient will be expected to return to the office 1 day post-op and then again at 5 days after the procedure. There will be 7 to 10 additional office visits expected within the first 3 months, another at 6 months, and then annually after that.
- Pain Relief – Ibuprofen and narcotics as needed.
The Initial Consultation
The initial conversation will cover patient concerns as well as past medical history. While age is not a limiting factor in most cosmetic procedures, it is a consideration in any surgical intervention. Patients should come prepared with any questions they may have and be equipped to answer frank questions from their surgeon.
Topics to be covered during this initial meeting include:
- Patient Expectations – The patient should be prepared to discuss their expectations for the procedure.
- Surgical Goals – The surgeon, after examination, will be able to define realistic goals for the lift, based upon the patient’s unique situation.
- Patient Choices – Based on surgical goals and patient expectations, the surgeon will be able to offer options for achieving the desired outcome.
- Surgical Fees – The fee for the procedure will depend upon the course of action selected. Fees for the surgical procedure will be collected in advance and include the surgery as well as all postoperative care. Fees for the facility and anesthesia will be collected separately the day of the preoperative visit at the surgical center.
Before the Brow Lift
Office staff, in coordination with the patient, will arrange the procedure to accommodate the necessary parties involved. Due to the staff requirements, there may be a slight waiting period in order to coordinate all staff needed for the procedure. Confirmation will be made phone and by mail when the date for the procedure has been set.
A prescription for post-surgical pain medication will be provided and should be filled prior to the day of surgery.
In order to achieve the most desirable outcome, the patient should be in good general health, fit, and illness-free. If there are any health concerns, or the patient is taking any medications – including over-the-counter supplements – this should be discussed during the initial consultation. While most supplements are beneficial and will not interfere with the procedure, some may interact with the anesthesia, causing complications. The surgeon can advise of any concerns related to medications and help plan a course of action regarding their use.
In order to insure a smooth recovery, Boulder Plastic Surgery follows a three-stage healing program to assist in speedy recovery:
- Nutritional supplements formulated to increase healing and reduce downtime are given to the patient approximately one week prior to surgery.
- Following surgery, the patient is supplied with nutrients designed to speed detoxification and reduce pain and swelling in the surgical area.
- Postoperatively, the patient will receive additional nutritional support to speed recovery and boost the immune system.
Prior to surgery, routine laboratory tests are conducted to check blood counts and blood chemistries to check for pregnancy (when applicable), and an electrocardiogram (for patients over 50 or with a history of heart defect) to check for any conditions, which may complicate the procedure.
It is recommended that patients avoid any drugs containing aspirin in the two weeks prior to surgery, as these may slow platelet function and affect normal blood clotting mechanisms. Patients should carefully check the ingredients on any medications prior to taking them to ensure that they do not contain aspirin.
When preparing for surgery, the patient should observe a number of protocols:
- Bathing – The patient may shower normally the night before surgery.
- Information – Inform your anesthesiologist if you have any previous history of nausea with general anesthesia. Anti-nausea medications can be administered prior to surgery to prevent an occurrence of stomach upset post-op.
- Fasting – The patient should not eat or drink for at least 8 hours prior to surgery.
- Attire – The patient should dress comfortably in loose-fitting clothing, including a loose shirt that buttons up the front – as opposed to one that must be pulled over the head.
- Transportation – The patient should make arrangements for transportation from the facility at the proper time post-op.
- Companionship – The patient should arrange to have someone stay with them the night following the procedure.
The surgeon will conduct a brief examination immediately prior to surgery and answer any final questions prior to beginning the procedure.
Prior to surgery the patient is given sedation through an intravenous line, in order to reduce the amount of medication required. The patient is encouraged to discuss any concerns with the anesthesiologist at this time.
Immediately prior to entering the operating room, the area of the procedure is marked and the patient receives the final preparations for surgery.
During the Procedure
Upon entering the operating room, the patient is positioned comfortably and any necessary additional medications are administered. Because general anesthetics can have a profound amnesic effect, the patient will typically have no recollection of the procedure.
A brow lift is typically performed by making several small incisions into the scalp and then using an endoscope to visualize the surgical site and instruments needed to perform the procedure. Through these incisions, the tissues of the forehead are undermined and the appropriate muscles are weakened. This allows the forehead tissues to be stretched upward. Great care is taken not to trim hair or damage the hair follicles so that the hair directly abuts the surgical incision, leaving no obvious bare areas.
When the procedure is complete, the patient is transferred to a recovery room to rest until awakening from anesthesia. After an appropriate period of observation, during which the patient’s vital signs are carefully monitored, the patient will be discharged and allowed to leave with an appropriate escort to drive them home.
The patient should have a small meal and one of the prescribed pain medications immediately upon returning home from the clinic. The after-effects of anesthesia will cause drowsiness and intermittent waking for several hours post-operative. The patient should make themselves comfortable and apply a cold-compress intermittently for 48-hours after surgery, using the prescribed pain medications as needed.
- Nausea – Although small meals should be consumed while taking the pain medications, large, heavy foods should be avoided as they may lead to nausea and vomiting. Patients experiencing nausea the evening following the procedure should avoid food and sip small amounts of water until morning. A normal diet should be possible the following day.
- Swelling and Discoloration – Swelling and bruising of the forehead, which may gravitate downward into the upper eye area, along with other noticeable bruising, are normal and should subside in 7-14 days. Discoloration of the area changing from purple to yellowish is also normal and will subside with time.
- Bathing – Normal hygiene can commence the day following surgery. The patient may wash and towel dry the hair and face, 48 hours after surgery. Excessive heat should be avoided due to numbness in the area, which could lead to accidental burns. Sensation will return as the sensory nerves regrow.
- Drainage – The patient should expect a small amount of drainage from the incision for a period of 48-72 hours, and is no cause for concern.
- Appearance – Brows will appear higher during the first few weeks postoperative. This is due to swelling of the tissues and will decrease over time. As swelling decreases, so will the feeling of tightness and the appearance of “high” eyebrows, which can be temporarily corrected using cosmetics and judicious brow plucking.
- Facial Movement – Movement of the forehead will be inhibited for the first few weeks following surgery due to swelling and the weakening of the forehead depressor muscles, which was accomplished during surgery. This will prevent a recurrence of deep wrinkling due to muscle action in the forehead. Movement will resume as the swelling diminishes and the tissues become more pliable.
- Antibiotics – Any prescription antibiotics prescribed post-op should be taken in their entirety to prevent the development of a resistant infection in the surgical area.
- Discomfort – Postoperative discomfort is most acute in the first 24 hours following surgery and lessens by half each 24 hours following the procedure. The resumption of normal activities, such as lifting the arms, and carrying light objects speeds recovery and should be encouraged. Immobility can lead to increased risk of muscle spasm and continued discomfort.
- Resumption of Activities – Normal activities may cause discomfort initially, but this will pass with time and is no cause for concern unless accompanied by significant pain. Most patients return to normal work/life schedules within 7-10 days following the procedure. Light exercise may be resumed 3 weeks following the procedure, including low-impact activities at 1/3 customary duration. Exercise tolerance should gradually increase to 2/3 intensity at 6 weeks and be returned to full intensity by 8 weeks post procedure. Maturation and strengthening of the scar tissue occurs over a period of 6-12 months. Overexertion can lead to longer healing times.
Patients will be eager to return to normal life and display the results of their surgery, but care should be taken not to over extend the body. Patience during the healing process ensures the best possible result from the procedure.
Risks and Limitations
As with any procedure, brow lift surgery comes with a risk of complications. While rare, they should be taken into consideration prior to scheduling the procedure:
- Asymmetrical Appearance – A certain level of asymmetry in the human face is normal and, often, goes without notice. After the procedure, these differences may become more noticeable to the patient due to a heightened awareness of the facial structure.
- Reactions to Medication – While uncommon, reactions to medications taken before, during, or after the procedure may occur. It is essential for the patient to be completely honest about drug sensitivities, as well as any medications or over-the-counter supplements that are currently being taken.
- Decreased Sensation – A common side effect of a brow lift is a slight lessening of sensation of the upper forehead area due to stretching of the facial nerves. The sensation of tingling or numbness is generally tolerable and subsides within a few weeks.
- Bleeding or Infection – Extremely rare in an endoscopic brow lift, excessive bleeding and the risk of infection are present in any surgical procedure.
- Hair Loss – Extreme care is taken to preserve the hair follicles in a brow lift procedure, however loss of small areas of hair in and around the incision do sometimes occur. Hair generally regrows in the affected area within a few months. Rogaine® may be suggested to stimulate hair growth.
- Muscle Weakness – Due to the nature of the procedure, muscles are weakened to preserve the correction of deep skin imperfections. The extent of residual weakness and residual expressive motion after the procedure vary from patient to patient and depend upon a variety a factors, but are generally minimal. Excessive weakening or nerve injury occur only rarely.
- Short-Term Depression – Any procedure that affects a patient’s appearance – even positively – can result in feelings or melancholy and self-doubt. These feelings generally subside within 1-3 weeks and are quickly replaced with feelings of renewed confidence as the short-term side effects of the procedure wear off.
While most of these complications are extremely rare, they can be dangerous if not attended to immediately. Patients should contact the office if they exhibit any of the following symptoms:
- Temperature of 101° or greater
- Extreme swelling or tenderness around the face or eyes
- Prolonged or significant bleeding from the incision line (slight drainage for the first 24 hours is normal and should be expected)
- Redness along the incision lines
Brow Lift Cost
The cost of the endoscopic brow lift procedure varies depending on the scope of the procedure, but can generally be expected to cost between $5,700 and $6,700. This fee includes the cost of the surgeon’s services, use of the operating room, and anesthesia. The exact fee for services can be determined at the initial consultation.
Thankful for Dr. Rouch
by Heather M
Last fall i was diagnosed with Breast Cancer and was referred to Dr. Rouch by my cancer surgeon for breast reconstruction. Dr. Rouch and his nurse Lana are so caring and thorough and helped me get through a very stressful time. Dr. Rouch explained my procedures in detail and was always available to answer my questions. I am very happy with my results and feel so lucky to have had Dr. Rouch as my surgeon.
Heather is the amazing!
Heather is wonderful to work with and goes above and beyond! She listens carefully and always comes up with a plan to address what is on my mind. Not to mention her approach is so calm and reassuring, explaining everything she is doing throughout the treatment. Heather is an all around wonderful person who is a true professional!
Elective surgery w/ Dr. Maxhimer
by Suzanne Simmons M.D.
I highly recommend this Plastic Surgery group. The Physicians are fully Board Certified M.D. Plastic Surgeons, and they have fully Board Certified M.D. Anesthesiologists doing their Anesthesia procedures. As an Internal medicine Physician, I was apprehensive as to who, exactly, would be doing my surgery, and who would be managing my airway and my anesthesia ( my Physician colleagues and I see cases more and more frequently of people who have not graduated from 4 years of Medical School, not done a minimum of 1 year of year-round Internship, not done a minimum of 3 years' year-round Residency, not done additional rigorous Fellowship training in their Surgical or Anesthesiology specialty, are not Board Certified from their national and fully accredited Specialy Board(s)and have catastrophic outcomes . A trial just occurred 2 weeks ago in Denver w/ just such a case ( Denver Post, June 14, 2023. "CO plastic surgeon acquitted of homicide in teen patient's death, convicted on lesser charges ").I was relieved to have Dr. Maxhimer explain to me that he would be doing my Surgery, and that a Board Certified Anesthesiologist would be doing my anesthesia. I was amazed at how quickly and seamlessly my surgery went. We are fortunate to have such a high level group here in Boulder. I will return to them if needed, and have referred several people to them. Thank you.
Dr. Rouch is excellent
I had liposuction on my stomach and thighs and under my chin. I’ve never had any surgical procedures before so I was nervous but Dr. Rouch and his team were warm, patient and reassuring from start to finish. My result is beautiful and natural looking and I couldn’t be happier. Recovery was smooth and I felt supported at every step along the way. Highly recommend!
Heather will get you glowing!
I’ve been seeing Heather for years and I’m always recommending her to everyone I know. She’s a rare combo of a wonderful person and a skilled practitioner. She’s honest and kind and always steers me in the right direction. I went to another practice in town and left because it felt like I was just a number. Heather is the exact opposite. She’s warm and cares about each client’s individual needs. She is thoughtful and patient and has great recommendations. You won’t find a better person to take care of your skin. She’s truly one of a kind!
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