What is a forehead lift (brow-lift)?
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.
Your surgeon may use the conventional surgical method, in which the incision is hidden just above the hairline; or the forehead lift may be performed with the use of an endoscope, a viewing instrument that allows the procedure to be performed with minimal incisions. Both techniques yield similar results -a smoother forehead and a more animated appearance.
The forehead lift (browlift) surgery
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 numb to pain.
Some surgeons prefer to use a general anesthesia, in which case you'll sleep through the entire operation. Typically, people are requested not to drink, eat and smoke for about six hours before receiving general anesthetic and may need to stay overnight in hospital.
The forehead lift procedure
Mimic muscle above the nose root
Your surgeon 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 your surgeon recommends and why he or she feels it is best for you.
The classic forehead lift
Before the operation begins, your hair will be tied back with rubber bands on either side of the incision line. Your head will not be shaved, but hair that is growing directly in front of the incision line may need to be trimmed.
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 above 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. By wearing your hair down on your forehead, most scars become relatively inconspicuous. Special planning is sometimes necessary for concealing the scar in male patients, whose hairstyles often don't lend themselves as well to incision coverage.
If you are bald or have thinning hair, your surgeon may recommend a mid-scalp incision so the resulting scar follows the natural junction of two bones in your skull and is less conspicuous.
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.
The incision is then closed with stitches or clips. Your face and hair will be washed to prevent irritation and the rubber bands will be removed from your hair.
Although some plastic surgeons do not use any dressings, your doctor may choose to cover the incision with gauze padding and wrap the head in an elastic bandage.
The endoscopic forehead lift
Typically, an endoscopic forehead lift requires the same preparation as the traditional procedure: the hair is tied back and trimmed above the hairline where the incisions will be made.
However, rather than making one long coronal incision, your surgeon 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 a higher position by sutures beneath the skin's surface or by temporary fixation screws placed behind the hairline.
Are you a good candidate for a forehead lift (browlift)?
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. 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 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. You can see before and after photos of forehead lift abroad procedures here.
Patients who are bald, have a receding hairline, or have had previous upper-eyelid surgery may still be good candidates for a forehead lift. The surgeon will simply alter the incision location or perform a more conservative operation.
Remember, a forehead lift can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them in detail with your doctor.
Before your forehead lift surgery
If you decide to consult a plastic surgeon, he or she will first evaluate your face, including the skin and underlying bone.
During your consultation, the surgeon will discuss your goals for the forehead lift and ask you about certain medical conditions that could cause problems during or after the procedure, such as uncontrolled high blood pressure, blood-clotting problems, or the tendency to develop large scars.
Your surgeon will give you instructions to prepare for the forehead lift surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. You may be asked not to use any medications containing acetylsalicyclic acid (such as Acylpyrin, Aspirin, Alnogon, Mironal, etc.) It can increase bleeding during and after surgery.
It is assumed that no acute illnesses will have occurred in the period at least three weeks before the planned operation (viral illness, cold, etc.) Report any illness to your doctor.
If you smoke, plan to quit at least one to two weeks before your surgery and not to resume for at least two weeks after your surgery.
If your hair is very short, you may wish to let it grow out before surgery, so that it's long enough to hide the scars while they heal.
Whether your forehead lift is done in an outpatient facility or in the hospital, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two.
After your forehead lift surgery
The immediate post-operative experience for a patient who has had a classic forehead lift may differ significantly from a patient who has the procedure performed endoscopically.
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, depending on your surgeon's preference.
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.
You may be told to keep your head elevated for two to three days following the forehead lift to keep the swelling down.
Swelling may also affect the cheeks and eyes - however, this should begin to disappear in a week or so.
As the nerves heal, numbness on 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.
Some of your hair around the incision may fall out and may temporarily be a bit thinner. Normal growth will usually resume within a few weeks or months. Permanent hair loss is rare.
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.
Forehead before and after the operation
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 worn out at first, but your energy level will increase as you begin to look and feel better.
How long with a forehead lift last?
Although a forehead lift does not stop the clock, it can minimize the appearance of ageing for years. As time passes, you many want to repeat the procedure. The average forehead lift lasts 5-10 years.
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.
This text has been created with the kind assistance of Tomas Dolezal, M.D.