What causes the aging face?

The face can be thought of as two layers: the outer skin and the deeper soft tissues which include fat and muscles. In youth, the skin has very few lines; the tissues are firm and smooth. As we grow older, the skin looses its elasticity. Factors that influence the rate and degree of the aging process are genetic, sun exposure, smoking, alcohol, general systemic illness and weight fluctuation. The deeper tissues are also affected by aging causing laxity and sagging of the upper, mid, and lower face. In the forehead the eyebrows sag; when the muscles contract to re-lift them, deep wrinkles form. In the mid-face the cheek fat falls causing loss of the cheekbone highlights and deep nasolabial creases. Sagging along the border of the jaw causes jowl fullness, and in the neck forms skin webbing. Fat in this area causes the double-chin.

How can this condition be corrected?

To improve upon skin damage and fine wrinkling, the use of creams, dermabrasion, chemical peels, laser, or Visage are required to resurface the skin. To lift the deeper tissues, a browlift is required in the forehead region and a facelift or rhytidectomy are used to tighten the mid-facial and lower neck skin region. These may be combined with other facial operations such as eyelid surgery, liposuction, chin, or cheek implants, and fat injections.

Will a brow/facelift help everyone?

Brow/face lifts are not effective for correction of generalized find wrinkling. There are other procedures for this as previously mentioned. In the past, standard lifts required large skin excisions and were reserved for older patients. With the new endoscopic techniques favored by Dr. Horton, the incisions are small and suitable for younger patients. The chief benefit of the endoscopic browlift over the traditional browlift techniques is that no strip of scalp is removed and sensation to the top of the scalp is generally maintained. The frowning muscles between the eyebrows can be removed and the brows are elevated through these small incisions. Some frown lines will remain after the surgery, however the the forehead will have a softer, more useful appearance. It should be noted that after a browlift the aging process does continue at the normal rate, however the procedure can be repeated to rejuvinate the results.

How is a Browlift performed?

The basic operation is designed to lift the eyebrows back to a more youthful level, remove the frowning muscles between the brows, and give the forehead a more rested look. There are many variations on the basic procedure. Deep plane brow lifting is a newly developed evolution of the standard brow lift procedures. This differs from the standard procedures in that the surgery is performed deep under the facial muscles and the dissection involves less cutting of the sensory nerves to the forehead. In the pure endoscopic technique, five small 1/2-inch incisions are made in the hairline and a telescope with a TV camera is introduced under the skin to free up the tissues The frowning muscles are removed and the eyebrows and forehead are lifted. This moves back the hairline slightly in younger patients. In older patients this may not be desirable and a strip of skin may be removed at the hairline leaving a small scar in this area. While this procedure only improves the forehead; the facelift procedure is commonly combined to simultaneously improve the mid and lower face.

What about the scars?

Scar tissue is the normal product of the body's healing process, so surgery is not possible without scars. However, Dr. Horton carefully plans the incisions so that they are as inconspicuous as possible: they lie within the hair in most people or right at the edge of the hairline for those who desire to have their hairline lowered. You must follow postoperative activity and wound care instructions to promote healing. The individual characteristic of natural healing are the main factors in determining scar appearance.

What are the more common complications?

A browlift is a low risk procedure, but as with any operation there are certain potential problems.

The complications of anesthesia apply even for minor surgery. Although rare, nerve damage can occur which may cause a varying amount of facial weakness or paralysis of the muscles that elevate the brow, close the eye, or affect the smile. These complications can be temporary or permanent. If temporary, it can take up to a year to improve. Asymmetry of the eyebrow may occur. As in all surgery, complications such as infection or bleeding can occur and require appropriate treatment including possible surgery. At times, fluid or blood may accumulate in the operative sites which may require aspiration, drainage, or removal by surgery. This risk increases with high blood pressure or intake of aspirin and like medications. There may be blistering, crusting, or loss of skin with delayed healing in areas where the skin has been undercut and pulled tightly. These risks are increased with smoking. There may be scattered areas of numbness over the face, forehead, scalp, neck, and ears following the surgery, which may persist for an indefinite period of time. Itching of the scalp is common.

Many patients will notice temporary diffuse thinning of the hair from the swilling of the scalp. Temporary or permanent hair loss around incisions is uncommon. Scar tissue forms lumps/irregularities under the skin that resolve over a few months. Swelling of the eyes can cause "water blister like" appearance temporarily. Irritation or dryness of the eyes may occur. Ridging of the scalp skin or in front of the ear usually smoothes out over time. To have optimal healing no smoking one month prior to surgery or 3 weeks after surgery is recommended as well as avoiding use of a nicotine patch or nicotine chewing gum during this period.