Blog

The Botox Browlift

How do you lift the brow with Botox?

This is a common request I receive from patients and is something not all injectors know how to assess properly. I want to outline proper assessment of brow position and how to avoid the much feared brow drop.

Step 1 – Assessment

Whoever is performing your injections should be assessing your brow position with your eyes closed! This is the most important part of the initial Botox/Dysport consultation. If they are not doing this, your chances of having a dropped brow are significantly higher. People naturally lift their brows when their eyes are open. Only when we close our eyes and really relax our forehead can the true brow position be assessed.

If your brow position sits below the rim of the eye socket with your eyes closed, Botox/Dysport should be used very conservatively in the frontalis muscle to prevent brow drop.

 

Brow Position with Eyes Open

 

Eyes Closed, Forehead Relaxed

 

Actual Brow Position (Where brows will fall if frontalis movement is eliminated)

Step 2 – Anatomy

Botox works by weakening muscles. If you weaken the upper forehead (frontalis) muscles, you will not get a brow lift, your brow will drop. The injector actually must weaken the muscles that pull down the brow. These muscles are the muscles BETWEEN the eyebrows (the 11’s, corrugator and procerus muscles) and along the OUTSIDE OF THE EYES (crows feet, orbicularis oculi). This allows decreased pulling of the eyebrows downwards and allows the frontalis muscle to lift the brow.

Step 3 – The Final Result

When the frontalis muscle is able to lift the brow, there is still upper forehead movement and wrinkles present, but the brow is now in a higher position. Again, this is the common misconception and something I educate my patients about. If you eliminate all horizontal forehead wrinkles then you will be dropping your brow down to the natural position of your brow (where it is with your eyes closed and your forehead relaxed).

Step 4 – Less is sometimes more

If you can understand these concepts, then you are steps ahead of many people that receive Botox/Dysport as well as many injectors! As my patients get older, I actually use less Botox in order to preserve a higher brow position.

Step 5 – Find someone you trust

If all this sounds rather confusing, then don’t worry! Find someone experienced that you trust to perform your injections. Preferably someone with a strong background and understanding of the facial anatomy and how it functions.

Lastly, are there surgical options to correct a low brow?

For patients with a low brow, the best correction that can both raise the brow and eliminate forehead wrinkles is a Browlift. This can be done through an endoscopic approach in most cases. Endoscopic browlifts are done through small incisions in the hairline and have minimal downtime. Most swelling and bruising is gone within 1-2 weeks.

Any questions? Don’t hesitate to email me: jordan@rihanimd.com

 

Post Rhinoplasty Expectations

Answering commonly asked questions about rhinoplasty surgery. Do I use nasal packing during surgery? What is the post operative visit like and is it painful?

How to Apply Retinol and Retin A

One of the most common issues patients have after starting retinol is peeling and skin sensitivity. Most often, the issue is actually improper application of the product. Start slow, apply as tolerated at night, and start in the oily parts of your face to prevent unwanted side effects. Check out our newest video with House of Preservation which sums everything up. And don’t forget to check out their blog at houseofpreservation.com!

 

What is the recovery for a facelift?

This is one of the most common questions I get, so wanted to answer this here.

What is the recovery for a facelift?

In general I say 2-3 weeks, although this varies for everyone. This is the amount of time that I generally recommend avoiding social gatherings or special events.

I do not use any drains after the surgery, so my patients are actually able to wash their hair the next day.

Is there a lot of bruising after a facelift?

Bruising and swelling vary from person to person. Some people have very little to no bruising, believe it or not. The majority of people fall somewhere in the middle with some light red bruising around the lower cheeks and neck. If eyelid surgery is performed at the same time, there is usually bruising around the eyes as well. Covering bruises with makeup is possible when the incisions have began to heal.

Some patients take Arnica Montana or Bromelain after surgery to expedite resolution of bruises.

Is a facelift painful?

Facial surgery tends to be well tolerated and patients rate pain levels as significantly lower than body surgery. I have some patients that take only tylenol after facelifts! I prescribe pain medications to all my patients and recommend they take them for the first few days.

What are the activity restrictions after a facelift?

Driving – If a necklift is performed at the time of your facelift, I require 2 weeks of no driving. If you look at the strength of a wound that is healing, 80% of the strength returns at 8 weeks. Any limiting of stretching and pulling (especially head turning during driving) will help prevent scar widening and compromise of your best result.

Exercise – return to light workout (walking) early after surgery is encouraged. I tell patients to avoid heavy lifting or neck straining for 8 weeks. If it feels tight, listen to your body!

 

Hope that answers a few of your questions. Feel free to email me with any others. Don’t forget to check out my facelift page.

 

JR

Lunch and Learn August 1st

Join us on Tuesday August 1st for our lunch and learn featuring Galderma.

Galderma is one of the global leaders in injectable aesthetic products and their US Headquarters is actual here, locally, in Fort Worth TX (which we love!). Their product line includes Dysport, Restylane, Restylane Silk, Restylane Lyft, Restylane Refyne, Restylane Defyne, and Sculptra.

The lunch and learn will be in our Southlake Office – 521 W Southlake Blvd, Ste 175 Southlake TX 76092 – from 11am to 1pm. Lunch and light refreshments will be provided. Product demonstrations will include a cheek augmentation featuring Restylane Lyft on a real patient. Raffles and give-aways at the door and discounts on all Galderma products, including injectables if appointments are made during the event!

RSVP is required so please email us at hello@facialplasticsurgeryinstitute.com

See you soon!

What is a Paramedian Forehead Flap?

What is a Paramedian Forehead Flap?

One of the most common ways to reconstruct the nasal tip is a flap known as the paramedian forehead flap. This uses skin and its blood supply borrowed from the forehead to replace lost skin of the nasal tip.

What does a Paramedian Forehead Flap look like?

The above example demonstrates the appearance of a paramedian forehead flap. This was used to recreate a nasal tip defect from skin cancer. There are two stages to this flap reconstruction. First step – rotate the forehead flap into place. This contains a flap of skin and its blood supply from the forehead. This is sewn into place over the nasal defect. The middle image demonstrates a finger-like connection between the patient’s eyebrow and the tip of the nose. This stays in place for approximately 4 weeks while new blood vessels grow from the nose into the forehead skin. The second step is to divide the flap blood supply and return excess skin back to the forehead while leaving the new skin on the tip of the nose.

What happens to the forehead when using a Paramedian Forehead Flap?

The forehead in most cases has enough elasticity that it can be closed easily. This heals up with a thin vertical scar that is about 4 inches long.

What are other options besides Paramedian Forehead Flaps for nasal tip defects?

There are other options for reconstructing the nasal tip including skin grafts, flaps taken from the cheek, and local flaps from the nose. The options are determined by the size of the defect and if the underlying cartilages are involved or if the inside lining of the nose is involved (which would require closure at the same time). I discuss all possible options with my patients prior to surgery. Closure using a paramedian forehead flap does allow similar thickness and color-match skin for an excellent cosmetic and functional result.

Should I have a facial plastic surgeon close my skin cancer defect?

I work closely with many Mohs surgeons in the DFW area for closure of nasal and facial skin cancer defects. I recommend patients with skin cancer of the face or neck see me prior to removal of skin cancer. This allows us adequate planning for the most streamlined process possible – often performing the closures on the same day as the removal!

Please do not hesitate to contact me with any questions and check our Facial Reconstruction page for more examples!

Total Facial Volume Replacement – Sculptra and Fat vs Gel Fillers

Total Facial Volume Replacement – Sculptra and Autologous Fat vs Gel Fillers

Misconceptions, Questions, and Expections

Is my face going to look too full or round? 

Short answer: No. I am replacing lost volume that has occurred.

Long answer: The face has lost about 25% of bone volume by age 60. That causes increased size of the orbits, decreased projection of the midface, and shortening of the mandible. Fat volume decreases (especially in temples, cheeks, and perioral areas) and the fat pads separate and descend down the cheek. Providing replacement of this loss in the proper locations, allows restoration of youthful shape and contour.

What is total volume loss? 

I use this term to refer to the changes described above. This differs from localized areas of volume loss that we routinely enhance such as the lips and cheeks. Total volume restoration allows more general replacement of the loss of subcutaneous fat.

What is the best filler to use for total volume replacement? 

There are currently two fillers that I feel address the total soft tissue loss that occurs in the face. Autologous fat (harvested from the patient) and Sculptra. Both allow soft improvement in the areas of volume loss without creating heaviness in highly mobile areas such as the lower cheeks.

I use these fillers to complement the typical gel fillers (Juvederm Voluma, Juvederm Ultra, Restylane, Belotero).  I continue to use gel fillers for bone-volume replacement (deep injections to provide structure) and for superficial, small-diameter wrinkles.

How long does Sculptra last?

Sculptra results last up to two years. It works by promoting the patient’s own collagen production. This collagen formation is appealing to many patients with its soft and natural feel. These results do take some time which is different than the immediate gratification of many of the other fillers I use.

Here is an example of a Sculptra injection schedule: 

Day 1: Injection of 2 vials of sculptra

Day 3: Back to normal without evidence of swelling.

Day 3-60: increasing collagen formation and volume replacement

Day 45-60: Injection of 2 vials of sculptra:

Day 60-120: further collagen formation

This can repeated for another cycle if needed.

Every year: Touch up with 1-2 vials of sculptra.

 

If you are interested in a consultation to see what the best options are for you, please get in touch with us! jordan@rihanimd.com

Have a great week!

JR

Schedule a Consultation
With Dr. Rihani

Call (817) 529-3232 or fill out the form below.

Schedule a Consultation