A forehead lift or brow lift is a procedure that restores a more youthful, refreshed look to the area above the eyes. The procedure corrects drooping brows and improves the horizontal lines and furrows that can make a person appear angry, sad or tired. 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. Makram may use the conventional surgical method, in which the incision is hidden just behind the hairline or he might carry out the surgery with an endoscope, a viewing instrument that allows the procedure to be performed with minimal incisions. Both techniques yield similar results – smoother forehead skin and a more lively appearance.
If you are considering a forehead lift, read the information provided on this page thoroughly in order to acquire a basic understanding of the procedure – when it can help, how it is performed and what results you can expect from it. You should know though that a lot depends on your individual circumstances. Therefore, make sure you consult your doctor if you have any questions that still need to be answered. A forehead lift or “brow lift” is a procedure that restores a more youthful, refreshed look to the area above the eyes. The procedure corrects drooping brows and improves the horizontal lines and furrows that can make a person appear angry, sad or tired.
THE BEST CANDIDATES FOR A FOREHEAD LIFT
A forehead lift is most commonly performed on patients within the age range of 40 to 60 who are looking to minimize the visible effects of aging. It is worth noting though that it can also help people of any age who have developed frown lines or furrows due to stress or muscle activity. Individuals with inherited conditions, such as a low, heavy brow or furrowed lines above the nose can get 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.
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 should always be considered. Another rare complication is the formation of a broad scar. This, however, can be surgically treated by removing the wide scar tissue so a new, thinner scar may result. Furthermore, some patients might experience hair loss along the scar edges. It is common to lose sensation along or just beyond the incision line, especially after the classic forehead lift procedure. And while this complication might be temporary for some patients, it might prove permanent for others.
Infection and bleeding are very rare but are to be considered.
If a complication occurs during an endoscopic forehead lift, Dr. Makram might be obliged to abandon the endoscopic approach and switch to the conventional, open procedure, which will involve a more extensive scar and a longer recovery period. It should be noted though that, to date, such complications remain rare – estimated at less than 1 percent of all endoscopy procedures. You can reduce the risk of complications by closely following Dr. Makram’s instructions both before and after surgery.
PLANNING YOUR SURGERY
For a better understanding of how a forehead lift might change your appearance, look into a mirror and place the palms of your hands on the outer edges of your eyes, above your eyebrows. Gently draw the skin up to raise the brow and the forehead area. This would give you a close idea of what a forehead lift would do for you.
When you consult Dr Makram, he will first evaluate your face, including the skin and the underlying bone.
During your consultation, Dr. Makram will discuss your goals for the surgery 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. Make sure you inform Dr. Makram if you have had previous facial surgery, you smoke or you take any drugs or medications – including aspirin or other drugs that affect clotting.
If you decide to proceed with a forehead lift, Dr. Makram will explain the surgical technique, the recommended type of anesthesia, the type of facility where the surgery will be performed, the risks and the costs involved. Don’t hesitate to ask your doctor any questions you may have, especially when it comes to your expectations and concerns about the results of surgery.
PREPARING FOR YOUR SURGERY
Dr. Makram will give you specific instructions to prepare for the procedure, including guidelines on eating and drinking, smoking and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery and recovery proceed smoothly. If your hair is very short, you may wish to let it grow out before surgery, so that it becomes long enough to hide the scars while they heal. Whether your forehead lift is performed in an outpatient facility or in the hospital, you should arrange for someone to drive you home after your surgery and help you out for a day or two.
ANESTHESIA USED FOR THE PROCEDURE
Most forehead lifts are performed under local anesthesia combined with a sedative to make you drowsy. You will be awake but relaxed, and although you might feel some tugging and mild discomfort, your forehead will be insensitive to pain. Some surgeons prefer to use general anesthesia in which case you sleep through the entire operation.
Dr. Makram will help you decide which surgical approach best achieves your cosmetic goals: the classic or “open” method, or the endoscopic forehead lift. Make sure you understand the technique that Dr. Makram recommends and the reason he believes it suits you best.
THE CLASSIC FOREHEAD LIFT
Before the operation begins, your hair will be tied 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 might have to be trimmed. For most patients, a coronal incision is 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 is not 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. For patients who are bald or losing hair, a mid-scalp incision that follows the natural pattern of the skull bones is sometimes recommended. 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, Dr. Makram 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 steps as the traditional procedure – the hair is tied back and trimmed behind the hairline where the incisions will be made.
However, instead of making one long coronal incision, Dr. Makram 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.
With the use of 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 are closed with stitches or clips and the area is washed. Gauze and an elastic bandage may also be used, depending on Dr. Makram’s preference.
AFTER YOUR SURGERY
The immediate post-operative experience for a patient who has had a classic forehead lift may differ significantly from a patient who had the procedure performed endoscopically. 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 receive 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 surgery 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 the top of your scalp may be replaced by itching. These sensations may take as long as six months to fully disappear. If bandages are 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 ten days and the temporary fixation screws within two weeks.
GETTING BACK TO NORMAL
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, including jogging, bending, heavy housework, sex, or any activity that increases your blood pressure, should be limited for several weeks; while 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.
YOUR NEW LOOK
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.