Question:  I have developed some irritating lines in my forehead from years at a stressful job.  I am having a browlift but I do not want to look artificial and expressionless as a result.  Will my browlift rob me of the ability to form facial expressions? 

Answer:  No, your browlift really should not rob you of the ability to form facial expressions but part of a standard browlift, at least in my hands, involves removing some of the corrugator and procerus muscles, which are the muscles that cause the frown lines between the eyebrows.  By removing portions of these muscles, it does limit patient’s ability to pull the eyebrows together and form these lines.  Otherwise, patients have the full ability to raise their eyebrows and, as the furrowing of the eyebrows is typically not an expression that one really truly wants to perform, it is seldom missed by patients who have undergone a browlift procedure.

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 Question: I am having my first Botox injection to erase some smile lines.  Will I have to worry about bruises showing when I return to work the day after my injections. 

 Answer:  More than likely, you will not have to worry about bruise after Botox injections.  I personally use an extremely small needle and do relatively slow injections of the Botox itself to try to minimize any bruising that could occur from the treatment.  Depending on what part of the face that you are having treated, the risk of bruising varies.  In the forehead and area between the eyebrows, bruising is exceptionally unlikely but, in the area of the crow’s feet, bruising does occasionally occur but typically is a region that is quite small and can be easily covered with makeup.

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Question:  I have to wear glasses in order to drive, read, and pretty much do anything productive on a daily basis.  I am having eyelid surgery soon, and I need to know when I can return to my normal schedule.  How long after my blepharoplasty can I start to wear my glasses or contacts again? 

 Answer:  Most of my patients can wear their eyeglasses immediately after a blepharoplasty and, if you are only having your upper eyelids treated, then you can actually wear your contacts pretty much immediately as well.  With lower eyelid blepharoplasties, I typically perform these through an incision in the pink part on the inside of the lower eyelid and, due to this fact, some swelling does occur in and around the eyeball that can make it difficult for patients who wear contacts to wear them.  I therefore recommend that they avoid wearing the contacts for the first week after the procedure but they can certainly wear their eyeglasses at any time.

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Question:  What are the potential risks and complications associated with facelift surgery? I am 44 years old and in good health. 

 Answer:  Well, overall, the risks from a facelift surgery are exceptionally low when performed in experienced hands.  But risks would include blood collection under the skin, which is called a hematoma, which would need to be evacuated if this would actually occur.  Other risks include injury to a nerve that provides sensation in and around the ear that could result in permanent numbness of this area and, depending on the technique of facelift performed, other risks would include injury to the facial nerve that could cause weakness of the muscles of facial expression. 

All of these risks are rather low, especially the risk to any motor nerve or facial expression damage.  The risk of a hematoma is approximately 5%.  The risk of injury to the great auricular nerve is approximately 7%, depending on which article you quote but, in my own personal hands, I have never had a patient tell me that they had permanent numbness, and I have certainly never seen direct injury to the great auricular nerve during any facelift that I have performed.  Injury to motor nerves is exceptionally rare and, though I have seen a few patients with some temporary weakness after a facelift, this is due to some mild injury to the nerve due to cauterization of minor bleeding during the procedure itself.  These mild injuries eventually resolve and the full function of the muscles of facial expression have always returned within approximately six weeks.  This is a very unusual complication but fortunately, at least in my own personal experience, this has never been a permanent consequence of facelift surgery.  All in all, the complication rate is exceptionally low and, typically, these sort of mild complications are only temporary and will leave no lasting results.

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Question:  I would like to get Botox treatments.  I am very glad that this is approved by the FDA.  What type of pain will I experience during the injections?  Is there anything I need to do after the injections to ensure that the Botox works the way it should? 

Answer:  Botox is an FDA-approved neuromodulator for the treatment of frown lines between the eyebrows.  We do, however, tend to use it off label in the forehead and crow’s feet as well as some other areas of the face.  Botox injections for the most part are very easy to tolerate when performed appropriately.  I personally use a 32-gauge needle when performing my Botox injections which makes the treatment nearly completely painless.  In fact, some patients hardly feel the actual injection itself. 

There is really not much that needs to be done after the injection other than I recommend that patients do not overly aggressively massage the area, and I recommend that they do not do any extremely strenuous activities, especially anything where they are straining or lifting heavy weights or activities such as yoga where they may be upside down, just to ensure that the Botox stays in the muscle where it was injected.  Otherwise, the effect of the Botox should be noticeable within a few days and maximized within approximately a week.  Classically, Botox lasts approximately three months in most patients but, in some, will last quite a bit longer as they essentially retrain themselves not to overly aggressively use the muscles that were treated.

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