IF YOU’RE CONSIDERING A BROW LIFT…
A forehead lift or “browlift” 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. Dolynchuk, in consultation with you, 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 new technique 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, the consultation will provide a basic understanding of the procedure — when it can help, how it’s performed and what results you can expect. Since a lot depends on your individual circumstances, be sure to ask your doctor 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 year age range for the following reasons:
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 they 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. 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 the doctor.
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 or botulinum toxin injection 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 requiring up to twelve months to recover, but may be permanent in some patients.
Infection and bleeding are very rare, but are possibilities.
You can reduce your risk of complications by closely following your surgeon’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 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 Dolynchuk, he will first evaluate your face, including the skin and underlying bone.
During your consultation, he 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 him 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, he 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 us any questions you may have, especially those regarding your expectations and concerns about the results of surgery.
PREPARING FOR YOUR SURGERY
We 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 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.
WHERE YOUR SURGERY WILL BE PERFORMED
A forehead lift is usually done in a surgeon’s office-based facility or an outpatient surgery center. However, it is occasionally done in the hospital.
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.
Some surgeons prefer to use general anesthesia, in which case you’ll sleep through the entire operation.
Dr Dolynchuk 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 feels it is best for you.
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 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 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. 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.
The endoscopic technique: This may be necessary in certain cases, utilizing incisions in the temple hair only, avoiding more conspicuous scars. Small incisions in the temple are used and an endoscope is inserted which guides the surgeon through the plane under the skin.
Working through either 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. The doctor may choose to cover the incision with light gauze padding or wrap the head in an elastic bandage.
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 minimal invasively.
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 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 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.
Incision site pain is usually minimal, but can be controlled with medication, if necessary. Endoscopic temporal forehead lift patients usually experience less of the itching sensation felt by patients who have had the classic forehead lift. However, bruising can be as severe, lasting up to three weeks.
The stitches used to close the incisions are usually removed within a week and the dissolving sutures fall out on their own.
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 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.
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.
ASPS, founded in 1931, is the largest plastic surgery organization in the world and the foremost authority on cosmetic and reconstructive plastic surgery. Dr. Dolynchuk is a physician member of ASPS and is certified by the American Board of Plastic Surgery (ABPS) and the Royal College of Physicians and Surgeons of Canada.