A forehead lift is a cosmetic surgery procedure intended to improve a person's appearance by correcting the shape of the eyebrows and reducing horizontal wrinkles or furrows in the skin of the forehead. It is also known as a brow lift.
The purpose of a forehead lift is improvement of the patient's external appearance, particularly with regard to the upper third of the face. Some people have clearly marked frown lines or drooping of the eyebrows or eyelid caused by loosening of the tissues and muscles around the eyes during the aging process. The drooping of the eyelid is sometimes referred to as ptosis, which comes from a Greek word meaning "fall." In some cases, these signs of aging make the person look angry, anxious, or sad. A forehead lift is not done to cure disease or repair a major wound or injury.
There are two main types of forehead lifts. The classic, or open, forehead lift involves a long incision along the top of the forehead and lifting of the skin of the forehead. The second type of forehead lift, known as an endoscopic lift, is performed with special instruments inserted through four or five small incisions behind the hairline.
In some cases, a forehead lift is combined with plastic surgery on the eyelids ( blepharoplasty ) or with a face lift .
Classic forehead lift
The classic forehead lift takes about one to two hours and may be performed with either general or local anesthesia. After the patient has been anesthetized, the surgeon makes a long incision across the top of the scalp from ear to ear. The exact location of the incision depends on the condition of the facial muscles to be removed or modified and the position of the patient's hair-line. The most common type of incision in an open forehead lift is a coronal incision, which is made slightly behind the hairline. A second type of incision is called a pretrichial incision. It is similar to the coronal incision except that the central part of the incision lies directly on the hairline. A third type of incision, which is used mostly on male patients with very deep forehead creases, is placed directly inside the creases in the midforehead.
After the incision has been made, the surgeon lifts the skin of the forehead very carefully and cuts away excess underlying tissue. Some of the muscles that cause frowning may be loosened (released) or altered. If necessary, the brows will be lifted and excess skin along the line of the incision will be trimmed away. The incision is usually closed with stitches or staples, although some surgeons are now using tissue glues to hold the skin in place. The patient's face is then carefully washed to prevent infection and irritation. Some surgeons prefer to cover the incision with a gauze dressing held in place by an elastic bandage, but others do not apply any dressing.
One disadvantage of the classic forehead lift from the standpoint of male patients is that men's hairstyles will not usually cover the incision scar. It is easier for women, even those who prefer to wear their hair very short, to let the hair grow for several weeks before the procedure so that it will be long enough to cover the scar.
Endoscopic forehead lift
An endoscopic forehead lift is performed with the help of an endoscope, which is an instrument designed to allow the surgeon to see the tissues and other structures underneath the skin of the forehead. Instead of making one long incision, the surgeon makes four or five shorter incisions, each less than an inch (2.5 cm) long. The endoscope is inserted through one of these incisions; the others are used for the insertion of instruments for removing excess tissue and reshaping the facial muscles. If the eyebrows are being lifted, they may be kept in place in their new position by tiny stitches under the skin or fixation tacks placed behind the hairline. The incisions are closed and the patient's face washed and dressed in the same way as in the classic forehead lift.
It is somewhat misleading to speak of diagnosis on the context of forehead lifts and similar procedures because cosmetic surgery is unique in one respect—it is the only type of surgery in which the patient initiates "treatment" rather than the doctor. This difference means that many plastic surgeons now screen patients for psychological stability as well as general physical fitness for surgery. Beginning in the 1970s and 1980s, psychiatrists began to see patients who were obsessed with a particular facial feature or other small part of their body, as distinct from overconcern about weight or general body shape. This condition, which is now called body dysmorphic disorder (BDD), became an official psychiatric diagnostic category in 1987. Patients with BDD frequently seek plastic surgery as a solution for their dissatisfaction with their looks. In many cases, however, the "flaw" that the patient sees in his or her face is either exaggerated or nonexistent. Ironically, although men are less likely than women to request facial surgery, a higher percentage of male cosmetic surgery patients are emotionally disturbed; one survey of plastic surgeons estimated that six out of every 100 female patients and seven out of every 100 male patients meet the diagnostic criteria for BDD.
When a person consults a plastic surgeon about a forehead lift or similar procedure, the doctor will spend some time talking with the patient about his or her motives for facial surgery as well as taking a general medical and surgical history. Good candidates for facial surgery are people who have a realistic understanding of the risks as well as the benefits of this type of surgery, and equally realistic expectations of the outcome. On the other hand, the following are considered psychological warning signs:
- The patient is considering surgery to please someone else, most often a spouse or partner.
- The patient expects facial surgery to guarantee career advancement.
- The patient has a history of multiple cosmetic procedures and/or complaints about previous surgeons.
- The patient thinks that the surgery will solve all his or her life problems.
- The patient has an unrealistic notion of what he or she will look like after surgery.
- The patient seems otherwise emotionally unstable.
If the surgeon thinks that the patient is a good candidate in terms of motivation, he or she will continue the diagnostic assessment by examining the patient's face at close range. To make an initial evaluation of the possible results of a forehead lift, the surgeon will gently lift the skin at the outer edges of the eyes above the brows in an upward direction. He or she may also ask the patient to look in a mirror and describe what they don't like about their face. Next, the surgeon will ask the patient to frown, smile, or make a variety of other facial expressions. This technique allows the surgeon to observe the activity of the patient's facial muscles. Depending on the amount of loose skin in the upper eyelid, the height of the patient's hairline, and the relative position of the eyebrows, the surgeon may recommend a blepharoplasty or other procedure instead of a forehead lift.
Preparation for a forehead lift involves practical as well as medical concerns.
MEDICAL AND HOME CARE ISSUES. A patient scheduled for a forehead lift will be asked to prepare for the operation by quitting smoking and discontinuing aspirin or any other medications that thin the blood. The surgeon will ask for a list of all medications that the patient is taking, including alternative herbal preparations as well as prescription drugs, to make sure that there will be no interactions with the anesthetic.
Patients are advised to have someone drive them home after the procedure and help them with routine chores for a day or two. If the forehead lift is combined with a face lift or blepharoplasty, the surgeon may have the patient remain in the hospital overnight. Although cosmetic surgery on the face does not interfere with walking or routine physical activity, most patients tire easily for the first few days after the procedure.
Classic forehead lift
Aftercare for a classic forehead lift is somewhat more complicated than for an endoscopic procedure. Pain or numbness around the incision is likely to last longer than for an endoscopic procedure. It is controlled with prescription medication. Patients are usually advised to keep the head elevated for two to three days after surgery to minimize swelling. Bandages are removed a day or two after the procedure; stitches or staples are taken out between 10 days and two weeks after surgery. The patient is asked to rest quietly for one or two days after surgery. Most patients can return to work after a week or 10 days.
Endoscopic forehead lift
Fixation devices around the eyebrows are usually removed within 10 days after endoscopic surgery. As of early 2003, however, new absorbable fixation tacks that do not require later removal are being used with good results.
Patients who have had either type of forehead lift should not wash their hair until the bandage or dressing is removed, usually within two days. Heavy lifting, vigorous athletic activity, sexual activity, or any type of exertion that raises the blood pressure should be avoided for five to six weeks after the surgery. The skin around the incision should be protected from direct exposure to the sun for at least six months, because the new tissue is much more vulnerable to sunburn than normal skin. Most surgeons advise patients to use a sunblock cream to protect the skin even after the first six months.
Patients can use a special camouflage makeup to cover the bruising or swelling that often occurs after surgery, although they should be careful to keep the makeup away from the incision. Most of the bruising and other signs of surgery will fade within about three weeks.
Major complications of a forehead lift are unusual. The most common risks from the procedure are as follows:
- Headaches for a day or two after surgery. This complication is much more common with a classic forehead lift than with endoscopic surgery.
- Mild pain around the incision for a few days after surgery.
- Numbness or itching sensations on the top of the scalp. These may last for as long as six months after surgery.
- Mild bruising or swelling around the eyelids and cheeks.
- Hair loss or thinning in the area of the incision. The hair will usually regrow within a few weeks or months.
- A feeling of numbness or dryness in the eye.
- Loss of function of the eyelid. This complication is corrected by another operation.
- Bleeding or infection. These are rare complications with forehead lifts.