FOREHEAD LIFT

Forehead Lift

A forehead lift can help people of any age who have developed furrows or frown lines due to stress, muscle activity, or inherited conditions, such as a low, heavy brow or furrowed lines above the nose. However, it is most commonly performed on people ages 40 to 60, to minimize the visible effects of aging. Forehead lift is often performed in conjunction with a facelift or eyelid lift surgery.

How is a Forehead Lift procedure performed?

Brow-lift procedures have evolved from open techniques to more complex short incision and endoscopic techniques. A brow lift usually involves incisions in the hair-bearing scalp, but sometimes incisions are made in the forehead and/or the upper eyelids.

• Open brow lift:

Your surgeon makes a long incision across the forehead, either around the hairline or in one of the creases of the forehead, and lifts the skin away from the underlying tissues. The surgeon then loosens muscles and removes fat. He or she removes any excess skin, pulls the remaining skin down, and stitches the brow into its new position. Other names sometimes used to describe open brow lift include classic, coronal or trichophytic brow lift.

• Endoscopic brow lift:

Your surgeon will insert an endoscope (a long, thin tube with a light at the end attached to a video camera) through several tiny incisions in the scalp. This allows your surgeon to see and work on the various internal structures of the forehead. The endoscopic technique requires very minimal incisions, but it may not be equally beneficial for all patients.

• Limited incision technique:

This hybrid technique of both procedures is non-endoscopic with limited incisions. It uses a small portion of the ends of the coronal technique incision to elevate the outside part of the eyebrows under direct vision without an endoscope. The resulting scars are hidden in the temporal hairline, even in balding men who have little temporal hair remaining. While this procedure does not address the center area of the brow, it can reduce wrinkles at the corners of the eyes, commonly referred to as ‘crow’s feet.’ Since many forehead-lift procedures are performed with an upper blepharoplasty, the upper eyelid incisions are used to complete the forehead-lift procedure by treating the ‘frown’ lines between the eyebrows and raising the inside part of the eyebrows.

The type of brow lift you undergo will be based on your facial features and aesthetic preferences. The goal of your aesthetic plastic surgeon and the entire staff is to help you achieve the most beautiful and natural-looking results, as well as to make your surgical experience as easy and comfortable as possible.

What will my brow lift incisions and scars be like?

The brow-lift incisions will be based on the technique your surgeon uses and will result in scars. The incisions are generally placed so they will be well concealed, frequently within or at the hairline, or within a deep forehead crease.

Open (coronal) technique. The incision is across the top of the scalp, beginning above the ears and hidden within the hair.

Endoscopic forehead lift. Your incisions may include three short incisions along the top of the scalp and a temple incision on each side. These incisions will be totally hidden within the hair.

Limited incision technique. The incisions will be hidden in the temporal hairline (temples). If your forehead lift is done in conjunction with an upper blepharoplasty, upper eyelid incisions will be used to complete the forehead lift by treating ‘frown’ lines between the eyebrows and raising the inside part of the eyebrows.

Are you a good candidate for a brow lift?

The following are some common reasons why you may want to consider a brow lift:

• The outside of your brow sags, resulting in a sad expression.
• The central portion of your brow hangs down, making you look angry
• You have frown lines between your eyes.
• If you are a female and you are unable to apply makeup on the upper eyelid, because the surface area has been obscured by drooping tissues as you have aged.
• If you gently lift the skin above your eyebrow into a pleasing position and it eliminates most of the excess skin in your upper eyelid, a brow lift may be right for you.

Rely on an evaluation from a board-certified plastic surgeon to find out if you would benefit from a brow lift, blepharoplasty, or both procedures. If you are in good general health, have a positive attitude and realistic expectations, you are most likely a good candidate for brow lift and eyelid surgery procedures.

Preparing for Your Procedure

Your surgeon will provide thorough preoperative instructions, answer any questions you may have, take a detailed medical history, and perform a physical exam to determine your fitness for surgery. Here are some of the preoperative instructions you can expect:

• If you smoke, your surgeon will ask you to stop at least six weeks before your surgery. Smoking greatly increases the risk of complications and slows the healing process.
• You may have to limit alcohol consumption and avoid certain medications.
• If you regularly take aspirin or another anti-inflammatory drug, your surgeon will ask you to stop taking these for a period before surgery. These drugs can cause increased bleeding.
• Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery.
• If your hair is short, you may want to grow it out to cover any scars.
• Make arrangements to be driven to and from surgery on the day of your procedure.
• You should have someone to take care of you on your first night home and, if possible, the first two days following surgery.
• Fill all prescriptions before surgery.
• Set up your recovery area ahead of time. You should have easy access to fluids, prepared meals, pillows to elevate your head, and reading materials and entertainment.
• Prepare ice packs. Frozen vegetables work well to reduce postoperative swelling.

What can I expect on the day of brow-lift surgery?

A brow lift may be performed in a surgeon’s office-based facility, an outpatient surgical center, or a hospital, and can take one to three hours to complete.

• Medications will be administered for your comfort during the surgical procedure.
• Local anesthesia combined with sedation is commonly used during brow-lift surgery, though general anesthesia can be used instead.
• For your safety during the surgery, various monitors will check your heart, blood pressure, pulse, and the amount of oxygen circulating in your blood.
• An anesthesiologist or nurse anesthetist will be present to administer sedatives (or general anesthetic) and assist in monitoring.
• Your plastic surgeon will follow the surgical plan discussed with you before your operation. Once surgery has begun, the surgeon may decide to combine various techniques or change a technique to ensure the best result. It is important that you feel comfortable and trust your doctor to make these decisions.
• Sections of hair will be held away from the surgery area.
• After removing excess tissue, skin, and muscle, your surgeon will close the incision with stitches or staples. Your hair and face will be washed so the scalp skin does not get irritated.
• The treated area will be wrapped with a sterile padding and an elastic bandage to prevent bleeding and swelling (edema). You will have sutures and a dressing on your forehead for the first few days after surgery. After surgery, you will be taken into a recovery area where you will continue to be closely monitored.

You can control temporary discomfort in the surgical site with medication. You may choose to go home on the day of surgery or spend the night with an office consultant or nurse, unless you and your plastic surgeon have made other plans for your immediate postoperative recovery. Under no circumstance will you be permitted to go home alone.

Recovery

Usually, you can expect the final result from surgery to be evident after six months. By then, the scalp and hairline incisions will have healed completely and you should be enjoying your more youthful appearance. Gravity will take its toll as aging continues, but portions of the brow lift, especially wrinkle lines in the brow and the frown line area, should never be as severe again and may return only mildly over the years. Life-long sun protection and a healthy lifestyle will help to maintain and extend the results of your more youthful appearance.