Individuals with inherited conditions - such as a low, heavy brow or furrowed lines above the nose - can achieve a more alert and refreshed look with this procedure.
A forehead lift is most commonly performed in the 40-60 age range to minimize the visible effects of aging. However, it can also help people of any age who have developed furrows or frown lines due to stress or muscle activity.
In a forehead lift, the muscles and tissues that cause the furrowing or drooping are removed or altered to smooth the forehead, raise the eyebrows and minimize frown lines. Dr. Patterson may use the conventional surgical method, in which the incision is hidden just behind the hairline; or he may use an endoscope, a viewing instrument enabling minimal incision. Both techniques yield similar results -- smoother forehead skin and a more animated appearance.
A forehead lift can smooth the forehead, raise the upper eyelids, and minimize the frown lines that come with aging.
Forehead lift is often performed in conjunction with a facelift to provide a smoother overall look to the face. Eyelid surgery (blepharoplasty) may also be performed at the same time as a forehead lift, especially if a patient has significant skin overhang in the upper eyelids. Sometimes, patients who believe they need upper-eyelid surgery find that a forehead lift better meets their surgical goals.
The classic forehead lift:
For most patients, a coronal incision will be used. It follows a headphone-like pattern, starting at about ear level and running across the top of the forehead and down the other side of the head.
The incision is usually made well behind the hairline so that the scar won't be visible.
If your hairline is high or receding, the incision may be placed just at the hairline, to avoid adding even more height to the forehead. In patients who are bald or losing hair, a mid-scalp incision that follows the natural pattern of the skull bones is sometimes recommended.
Working through the incision, the skin of the forehead is carefully lifted so that the underlying tissue can be removed and the muscles of the forehead can be altered or released. The eyebrows may also be elevated and excess skin at the incision point will be trimmed away to help create a smoother, more youthful appearance.
Forehead skin is gently lifted and portions of facial muscle and excess skin are removed. The incision is then closed with stitches or clips.
The endoscopic forehead lift:
Typically, an endoscopic forehead lift requires the same preparation steps as the traditional procedure: the hair is tied back and trimmed behind the hairline where the incisions will be made.
However, rather than making one long coronal incision, Dr. Patterson will make three, four or five short scalp incisions, each less than an inch in length.
An endoscope - which is a pencil-like camera device connected to a television monitor - is inserted through one of the incisions, allowing the surgeon to have a clear view of the muscles and tissues beneath the skin. Using another instrument inserted through a different incision, the forehead skin is lifted and the muscles and underlying tissues are removed or altered to produce a smoother appearance.
The eyebrows may also be lifted and secured into their higher position by sutures beneath the skin's surface or by temporary fixation screws placed behind the hairline.
When the lift is complete, the scalp incisions will be closed with stitches or clips and the area will be washed. Gauze and an elastic bandage may also be used.
Length: 1 to 2 hours
Anesthesia: Most forehead lifts are performed under local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and although you may feel some tugging and mild discomfort, your forehead will be insensitive to pain.
In/Outpatient: A forehead lift is usually done in the surgeon's office facility or an outpatient surgery centre. However, it is occasionally done in the hospital.
Side Effects & Risks
All surgery carries some uncertainty and risk. Complications are rare and usually minor when a forehead lift is performed by a qualified plastic surgeon. Yet, the possibility of complications must be considered.
In rare cases, the nerves that control eyebrow movement may be injured on one or both sides, resulting in a loss of ability to raise the eyebrows or wrinkle the forehead.
Additional surgery may be required to correct the problem. Formation of a broad scar is also a rare complication. This may be treated surgically by removing the wide scar tissue so a new, thinner scar may result. Also, in some patients, hair loss may occur along the scar edges. Loss of sensation along or just beyond the incision line is common, especially with the classic forehead lift procedure. It is usually temporary, but may be permanent in some patients.
Infection and bleeding are very rare, but are possibilities.
LOSS OF SENSATION: The upper part of the forehead and the top of the head usually experience reduced or absent sensation for several months to a year (or even longer)* after surgery. As the sensory nerves regenerate, patients normally experience tingling, shooting sensations, or itching. Massage usually relieves the symptoms.
HAIR LOSS: A few patients experience hair loss in front of the incisions. When it does occur, it usually last only several months*, during which the fair follicles remain in a resting phase.
ITCHING: Areas of itching in the forehead or scalp may occur and be annoying for a few months*.
NERVE INJURY: Permanent motor nerve damage (loss of motion of one or both sides of the forehead) is possible, but unlikely. Some weakness of one or both sides of the forehead can occur after surgery. In this occurrence, partial or complete improvement usually occurs after several months or a year or more*.
ASYMMETRY: Please realize that everyone’s face is uneven from side to side. This will not be changed by this surgery. Preoperative differences in the appearance of your eyebrows will usually not be corrected by a browlift. Small height differences between the two brows may usually be corrected.
CONTOUR ABNORMALITIES: Partial removal of the muscles that cause frowning or forehead wrinkling may leave small skin depressions. This is not common, and if it occurs, is mild.
Classic forehead lift patients may experience some numbness and temporary discomfort around the incision, which can be controlled with prescription medication. Patients who are prone to headaches may be treated with an additional longer-acting local anesthesia during surgery as a preventive measure.
As the nerves heal, numbness on the top of your scalp may be replaced by itching. These sensations may take as long as six months* to fully disappear. If bandages were used, they will be removed a day or two after* surgery. Most stitches or clips will be removed within two weeks, sometimes in two stages.
Endoscopic forehead lift patients may experience some numbness, incision discomfort and mild swelling.
Incision site pain is usually minimal, but can be controlled with medication, if necessary. Endoscopic forehead lift patients usually experience less of the itching sensation felt by patients who have had the classic forehead lift.
The stitches or staples used to close the incisions are usually removed within a week and the temporary fixation screws within two weeks*.
Although you should be up and about in a day or two*, plan on taking it easy for at least the first week after surgery. You should be able to shower and shampoo your hair within two days*, or as soon as the bandage is removed.
Most patients are back to work or school in a week to 10 days*.
Endoscopic patients may feel ready to return even sooner.
Vigorous physical activity should limited for several weeks, including jogging, bending, heavy housework, sex, or any activity that increases your blood pressure. Prolonged exposure to heat or sun should be limited for several months*.
Most of the visible signs of surgery should fade completely within about three weeks*. Minor swelling and bruising can be concealed with special camouflage makeup. You may feel a bit tired and let down at first, but your energy level will increase as you begin to look and feel better.
If a complication should occur during an endoscopic forehead lift, your surgeon may have to abandon the endoscopic approach and switch to the conventional, open procedure, which will result in a more extensive scar and a longer recovery period. To date, such complications are rare -- estimated at less than 1 percent of all endoscopy procedures.
Most patients are pleased with the results of a forehead lift, no matter which surgical method was used. Often, patients don't realize how much their sagging forehead contributed to the signs of aging until they see how much younger and more rested they appear after the lift.
Although a forehead lift does not stop the clock, it can minimize the appearance of aging for years. As time passes, you may want to repeat the procedure. Usually 5 to 10 years*.
Q. I am balding, am I still a candidate for a forehead lift?
A. Patients who are bald, who have a receding hairline, or who have had previous upper-eyelid surgery may still be good candidates for forehead lift.
Q. Which approach (classic or endoscopic) would be best for me?
A. Dr. Patterson will help you decide which surgical approach will best achieve your cosmetic goals: the classic or "open" method, or the endoscopic forehead lift. Make sure you understand the technique that he recommends and why he feels it is best for you.