Facial Scarring
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Author(s): Tom Shokri, MD (Penn State Hershey Medical Center): Jessyka G Lighthall, MD (Penn State Hershey Medical Center)
Overview: Aging typically results in decreased elasticity of the skin and soft tissues of the face. This often results in the formation of lines across the forehead and between the eyes. As this soft tissue loses elasticity, the distance between the eyebrows and eyelashes also shortens, resulting in the perception of a lower brow.1,2 This malpositioning of the brow, in addition to deepening of wrinkle may make one appear tired or angry. A brow lift can soften facial lines, raise the eyebrows and restore a softer, more pleasing appearance. A blepharoplasty is a surgical procedure that repairs droopy eyelids and may involve removal of excess soft tissues. Symptoms: You may be an appropriate candidate for a brow lift if you have: Creases across your forehead or high on the bridge of your nose, between your eyes Vertical creases between your eyebrows A low or sagging brow that's contributing to sagging upper eyelids You may be an appropriate candidate for blepharoplasty if you have: Baggy or droopy upper eyelids Excess skin of the upper eyelids that interferes with your vision Excess skin on of the lower eyelids Bags under your eyes Severe sagging of skin around your eyes and eyelids may, in addition to being unsightly, have a functional impact on your vision. It may in fact reduce your peripheral vision, particularly in the upper and lower field of vision. Blepharoplasty may be helpful in reducing or eliminating vision problems that are attributable to excess skin while making you appear younger and less fatigued. What to Expect at Your Otolaryngologist Office Visit: Initially, your evaluation will begin with a review of your medical history. Be prepared to answer questions regarding your current and prior medical conditions. Your current medications will be reviewed as well as any surgical procedures you’ve had performed in the past. Tell your provider if you are allergic to any medications. To best determine your treatment options, the physician will then perform a physical exam. The provider may also take photographs for your medical record. It is important to have a frank discussion regarding your expectations during your initial visit. Explain your main concerns and your goals in terms of your appearance after your procedure. The risks, benefits, and realistic goals will be discussed. Prior to undergoing any procedures, your doctor will ask you to stop smoking. This is due to the fact that smoking decreases blood flow to areas and increases your risk of vascular disease. This results in considerable impairment to your healing process following surgery. Patients are instructed to avoid the use of anticoagulants (Warfarin, Eliquis) prior to surgery. The physician that manages your anticoagulants will need to determine how long prior to surgery you need to stop taking these medicines. Aspirin and nonsteroidal anti-inflammatory drugs should also be discontinued for at least 2 weeks before surgery. Smoking must be discontinued for at least 4 weeks before surgery. All herbal preparations, vitamins, and homeopathic treatments should also be avoided for 2 weeks before surgery because of the risk of postoperative bleeding and intraoperative anesthetic complications. Additionally, if you have chronic medical conditions, close communication will be required with your primary care physician, and any specialists involved in your care, to determine suitability for elective surgery and obtain medical clearance. Herbal supplements to avoid prior to surgery include: Ginkgo biloba , St. John’s wort, Echinacea, ginseng, valerian, glucosamine, vitamin C (>2000 mg daily) fever few, golden seal, vitamin E (>400 mg daily), Fish oils (omega-3 fatty acids), garlic, licorice, Kava, or Licorice3 Treatment: Both browlift and blepharoplasty are performed either in a hospital or outpatient surgical facility. During these procedures, you will be placed under general anesthesia –rendering you unconscious. These procedures vary on a case by case basis depending on desired results and an individual’s anatomy. The specific techniques used by your plastic surgeon for brow lifts may be one of the following 4,5:
Following blow lift surgery, your forehead may be taped and your head might be wrapped loosely to decrease swelling. A small plastic tube, a drain, may be placed along the incision line to drain any excess blood or fluid that may accumulate under the skin and soft tissue. Blepharoplasty is also performed in an outpatient setting. This procedure is often done in combination with a brow lift or may be done independently. A cut is made along the fold of the upper eyelid, and any excess soft tissue is removed. The incision is then closed and camouflaged within the eyelid crease. The lower lid incision is performed either below the eyelashes, within the natural crease, or inside the lower lid. Excess tissue is again removed and the incision closed. After your procedure you will likely spend sometime in the recovery room, where you are monitored. You then leave later the same day to recuperate at home. Your surgeon will discuss specifics regarding wound care with your following your procedure on the day of surgery. Further Reading: https://www.aafprs.org/patient/procedures/blepharoplasty.html https://www.mayoclinic.org/tests-procedures/brow-lift/basics/definition/prc-20087441 https://www.plasticsurgery.org/cosmetic-procedures/brow-lift/procedure References:
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