After Endoscopic Brow Lift
WHAT CAN I EXPECT AFTER SURGERY?
There will be a mild to moderate amount of pain and discomfort associated with the surgery. This should be easily controlled with oral medications. Severe pain is rare; if you experience this, please contact us immediately.
The discomfort and pain should begin to decrease within 48 hours after surgery. A significant increase in pain after this period should prompt you to call the office.
At the time of surgery, Dr. Ducic may or may not place a large cotton compression dressing over your forehead and scalp. There may or may not, in addition be a small drain as well. If there is a dressing, this dressing may remain in place for up to one week after surgery. It serves to help prevent blood collections under the skin. If a drain is used, before leaving for home on the day of surgery you (or someone looking after you) should feel comfortable emptying and resetting the drain.
You may notice some slight drainage from the small incisions in your scalp for the first 2-to-3 days after your surgery. This is not unusual.
A sense of tightness in the forehead and brow region is to be expected after surgery. There will also be some tightness and discomfort over the top and back of the scalp as this entire area has also been repositioned with the surgery.
After the surgery you will notice some bruising and swelling, especially over the upper eyelids (sometimes over the lower eyelids as well since bruising will descend downwards secondary to gravity) and bridge of the nose. Occasionally the swelling may be enough to close the eyes. This is most likely to occur about 36-to-48 hours after surgery, as the swelling usually peaks at this time. After 48 hours the swelling and bruising rapidly subside. To minimize the swelling, sleep with your head elevated for 4 weeks after surgery.
In the first 2-to-3 weeks after surgery, the brows may appear to be excessively elevated. Do not worry, they will settle to a more normal position with time. Your final brow position will be appreciable at approximately 6 months.
It is of utmost importance to tell Dr. Ducic ahead of time if you have ever been on Accutane, received radiation therapy to the head or neck, taken steroids or immuno suppressive agents.
Immunosuppressed patients (HIV positive, chemotherapy, AIDS etc.) and patients with certain autoimmune disorders may not be good candidates for this procedure as the risks of poor healing and infection leading to permanent scarring and poor aesthetic results may be much higher. It is mandatory that you inform Dr. Ducic if you have any of these conditions before surgery.
CALL THE OFFICE PROMPTLY IF YOU NOTICE ANY OF THE FOLLOWING:
- significant progressive increase in pain which is not easily relieved by taking your prescribed medication.
- development of a temperature exceeding 100.0 degrees, unusual bleeding or purulent discharge from the incisions.
- there is a change in your vision.
If any of the above should occur after regular office hours, do not hesitate to reach us through the answering service. For whatever reason, if you notice one of the above changes and cannot reach us at our office or through the answering service,present yourself to the emergency department for evaluation.
HOW DO I CARE FOR MYSELF AFTER SURGERY?
Be sure to fill your prescriptions before your surgery since it means one less thing for you to worry about afterwards.
Take the antibiotics and pain medication only as prescribed by the office.
Do not take any aspirin or any anti-inflammatory compounds for 2 weeks before and 2 weeks after your surgery unless you first discuss it with your surgeon.
Make arrangements to have someone drive you to, and from, your surgery.
Having someone stay with you on at least the first night after your surgery is highly recommended.
If you are a smoker, you should not smoke for at least 2 weeks prior to surgery and 3 weeks after surgery. Smoking and chewing tobacco inhibit your circulation and can significantly compromise your surgical outcome.
You should thoroughly wash your hair with an antibacterial shampoo (such as Hibiclens®) or soap (available in drug stores) the night before surgery. You may also be given a prescription for antibiotic ointment before surgery. If so, apply a small amount to the inside of the nose three times a day for three days prior to surgery.
To minimize swelling around the eyes, you may use cool, clean compresses or ice wrapped in a dry cloth. Apply these gently to your closed eyes four-to-six times a day for the first twenty four hours after surgery. It is impractical to apply the ice or compresses to the forehead area, as this area will be covered with a cotton dressing for the first four days after the surgery. If no dressing is used,then ice may be applied to the forehead region as well.
Arrive for your surgery in loose, comfortable clothing. Your top should button or zip rather than pull over your head.
Sleep with your head elevated for 4 weeks after surgery.
It is not unusual to have some slight drainage from the small incisions in your scalp for the first few days after your surgery. The drainage is most often red or pink.
Occasionally, your eyes may feel dry or irritated for up to several weeks after your surgery. Using a natural tear solution or saline solution during this period, may be helpful. You may purchase natural tear solutions in any drug store without a prescription.
Surgical staples are most often used to close the small incisions in your scalp. These will be removed between 10-to-21 days after the surgery. Sometimes, tiny metal screws (the size that you normally find in eyeglass frames) are also used to help maintain your scalp position. If these are utilized, they will be removed at the time of staple removal. It is important to realize that removal of both staples and screws is almost painless. This should not be a source of any concern for you.
After you remove the second lighter compressive dressing at day 4, you (or someone looking after you) should start cleaning the small scalp incisions. This is accomplished by rolling a Q-tip moistened (not soaked) with hydrogen peroxide over each of the incisions, and then gently applying a small amount of antibiotic ointment on it. This procedure should be repeated 2-to-3 times per day. You may purchase the ointment in any drug store without a prescription (polytopic, Polysporin®, or bacitracin) or use Bactroban® ointment if it was prescribed for you. After 1 week, you should generally use a small amount of Vaseline on the incision (after cleaning with hydrogen peroxide) instead of the antibiotic ointment because some people will develop a slight local skin reaction (redness) if antibiotic ointments are used for longer periods. Occasionally, Dr. Ducic will ask you to use antibiotic ointments for longer than 1 week. Such cleansing is required for only the first 3 weeks after the surgery.
On the fourth day after the surgery, you may remove the compressive dressing, and begin showering. If there is no dressing, you may begin showering on day number four. At this time, you should start shampooing your hair. A good conditioner is usually required to fully detangle your hair. Be careful when shampooing around the scalp incisions so that you do not create any discomfort for yourself.
After you remove the compressive dressing, you should wear a broad tennis headband over your forehead at all times (except when showering) for 7-to-10 days. Then, you should wear it at night only for the next 3 weeks.
In addition to a sensation of tightness across the forehead, the forehead and scalp will feel numb. The area of numbness will gradually get smaller. Occasionally, this numbness may persist to a small degree indefinitely. It is important to be very cautious when blow drying your hair or when using a curling iron. As a result of the decreased sensation in your scalp, you may not be able to fully appreciate the heat generated by these devices.
You should avoid vigorous exercise or strenuous exertion such as lifting or straining for a minimum of 3 weeks following surgery. Plan on taking it easy.
Do not massage, rub or place any tension on the incisions for a minimum of 4 weeks after your surgery.
After the surgery, for a variable amount of time, you will find it difficult to grimace. This is beneficial, as it nearly eliminates or significantly reduces the large wrinkles between the eyebrows.
Approximate recovery after endoscopic brow lift is as follows:
DAY 1: Return home, leave any surgical dressing undisturbed until it is removed in the office. May use ice or cool compresses for the first 24 hours. Bruising and swelling moderate.
DAY 2-3: Aching, throbbing. Maximum swelling and bruising. Forehead and scalp tightness.
DAYS 4: Remove any dressing at home. Take a shower. Start cleaning wound with hydrogen peroxide followed by application of antibiotic ointment. Repeat 2-to-3 times per day. Wear headband at all times except when showering or cleaning incisions. Brow position seems too high (don’t worry, they will settle to a more normal position).
DAYS 10-21: Surgical staples removed in office. Bruising and swelling greatly improved. May start wearing headband at night only for the next 3 weeks.
DAY 21: No longer need to clean incisions or apply ointment.
DAYS 14-35: Numbness subsiding. Often feel prickly, electric sensations across the forehead and scalp as the nerves begin to regrow.
6 Months: Nerve symptoms have usually mostly resolved. May have small persistent areas of scalp numbness (generally not bothersome). The brows have reached their final position by this time. Enjoy your result.
REMEMBER: If you have any concerns or questions, please contact our office any time. Our office should be a source of information and reassurance throughout this entire experience, from the time of your first consultation and continuing after your surgery.
Call us at Head & Neck Oncologic, Reconstructive & Skull Base Surgery Phone Number 817-920-0484 with any questions about our practice or to schedule an appointment with Dr. Ducic.