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 furrowing or drooping are removed or altered to smooth the forehead, raised the eyebrows and minimize frown lines. Your surgeon may use the conventional surgical method, in which the incision is hidden just behind the hairline; or it 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 - smoother forehead skin and a more animated appearance.
If you're considering a forehead lift, this information will provide a basic understanding of the procedure - when it can help, how it's performed and what results you can expect. It won't answer all of your questions, since a lot depends on your individual circumstances. Be sure to ask Dr. Jensen if there is anything you don't understand about the procedure.
The best candidates for a forehead lift
A forehead lift is most commonly performed in the 40-60 are 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.
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 hey need upper-eyelid surgery find that a forehead lift better meets their surgical goals.
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. Dr. Jensen 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 Dr. Jensen.
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 be 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.
If a complication should occur during an endoscopic forehead lift, Dr. Jensen 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.
You can reduce your risk of complications by closely following Dr. Jensen'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 our hands at the outer edges of your eyes, above your eyebrows. Gently draw the skin up to raise the brow and the forehead area. That is approximately what a forehead lift would do for you.
If you decide to consult Dr. Jensen, he will first evaluate your face, including the skin and underlying bone.
During your consultation, Dr. Jensen 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. Be sure to tell Dr. Jensen if you have had previous facial surgery, if you smoke, or if you take any drugs or medications - including aspirin or other drugs that affect clotting.
If you decide to proceed with a forehead lift, Dr. Jensen 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 Dr. Jensen any questions you may have, especially those regarding your expectations and concerns about the results of surgery.
Preparing for your surgery
Dr. Jensen will give you specific instructions to prepare for the procedure, including guidelines on eating and drinking, smoking, and taking and avoiding certain vitamins and medications. Carefully following these instructions will help your surgery and your recovery proceed more smoothly.
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 scares 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.
Where your surgery will be performed
A forehead lift is usually performed in our office-based facility, on an outpatient basis; rarely does it require an inpatient stay.
Anesthesia used for the procedure.
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.
Sometimes Dr. Jensen prefers to use general anesthesia, in which case you'll sleep through the entire operation.
What are my options for incisions?
The brow-lift incisions will be based on your anatomy and how much of a correction is needed. The incisions are generally placed so they will be well concealed, frequently within or at the hairline.
Open (coronal) technique. This technique is rarely used anymore and has few indications. The incision is across the top of the scalp, beginning above the ears and hidden within the hair.
Endoscopic forehead lift. This is the most common type of forehead lift that Dr. Jensen performs. 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 ( Subcutaneous) 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.
A. The endoscopic brow lift uses several small incisions within the hairline.
B. Once incisions are made, the lateral aspect of the eyebrows are raised and repositioned along with the underlying muscle (as needed).
Dr. Jensen 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 Dr. Jensen recommends and why he feels it is best for you.
The classic forehead lift: before the operation begins, you 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 may need to be trimmed.
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. By wearing your hair down on your forehead, most such scars become relatively inconspicuous. Special planning is sometimes necessary for concealing the scar in male patients, whose hairstyles often don't lend them as well to incision coverage.
If you are bald or have thinning hair, Dr. Jensen 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 he 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, Dr. Jensen 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, rather than making on long coronal incision, Dr. Jensen 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 Dr. Jensen 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 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 device, which is dissolving, placed behind the hairline.
When the lift is completed, 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 Dr. Jensen'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 be treated with an additional longer-acting local anesthesia during surgery as a preventive measure.
Dr. Jensen will give you written instructions on how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will also receive detailed instructions about your postsurgical care, including information about:
- Incision care
- Normal symptoms you will experience
- Any potential signs of complications
It is vitally important that you follow all patient care instructions provided by Dr. Jensen, and that you realize that the amount of time it takes for recovery varies greatly among individuals.
Immediately after your brow lift
- Icing or cold packs should be used around the eyes for seventy-two hours to reduce the swelling.
- It is best to sleep with your back and head elevated for approximately seven to ten days.
- Dr. Jensen will likely ask you to come back to his office the day after surgery so he can evaluate your healing.
- Pain is typically not a significant problem in brow lifts. There is, however, some discomfort and tightness from ear to ear across the top of the head and brow. Most patients describe their forehead as feeling tight and somewhat numb the night of surgery and complain of a headache. You will be provided with pain medications should you need them.
- A single drains is usually placed in the brow area when doing an endoscopic brow lift.
- Temporary bruising, swelling, and numbness are common the first night after surgery. Maximum swelling occurs forty-eight to seventy-two hours post-surgery and begins to subside on the fourth or fifth postoperative day.
- You may need to go to the bathroom frequently because of the intravenous fluids you were given during your surgery. Drink plenty of fluids (such as Gatoraide) to keep up with the fluid loss. As your body begins to balance itself, it will rid itself of this extra 'water weight' and return to normal.
- Bruising from a brow lift appears less in the brow than in neighboring areas. As a result, any bleeding usually collects below the eyelids and bruises the lower lids, even if the lower lids are not operated on. Bruising usually peaks on the third to fifth day and resolves over two to three weeks. Warm compresses will help them resolve sooner.
- Showering and bathing are permitted the next day after the drain is removed. Use hair conditioner to help wash and clean hair that became matted or knotted during surgery. Be cautious when applying hot water, hair dryers, and combs; your scalp will be numb, so they may result in a burn.
Recovery time frame following a brow lift
- Your staples will be removed approximately one week after surgery.
- During the first week of recovery, you should move frequently, including going for walks to aid circulation in your lower extremities. However, do not attempt heavy lifting or strenuous activity.
- You can resume driving when you are able to drive as well as you did before surgery. You need to be able to brake, respond, and turn quickly. When these conditions are met, you may resume driving, typically in the second or third week after surgery.
- You may be able to return to work within a week and to full activity within a few weeks, but you must avoid heavy lifting or straining during this time.
- Sensation in your scalp may be temporarily reduced. The feeling will begin to return over the first few weeks after surgery and your scalp will begin to feel 'itchy' as the nerves reawaken. Total numbness behind the incision in an open brow lift will usually persist for nine to twelve months post-surgery, sometimes longer in rare instances.
One month following surgery
- You should have returned to your normal activites at work by this time, depending on the amount of physical exertion required to perform your duties.
- Begin exercise and workout routines. Avoid any activity that causes discomfort and/or pain until you are further along in your recovery process. When you return to the activity, start at a slower pace and increase to your normal routine as long as you do not feel any pain during and/or the day after your workout.
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 eye-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 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.
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 ten 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.
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.