Forehead Lift Surgery
Other terms associated with Forehead Lift Surgery: Brow Lift, Browplasty.
A forehead lift, also commonly referred to as both a browlift and a browplasty, is a procedure which elevates drooping eyebrows that obstructs vision, or to remove the deep creases “worry lines” that cover the forehead and may portray unintended emotions.
Patients often request this form of surgery because the area makes up a major focal point for expression of the upper face (along with the eyes). No one can escape the seconds of time or the pull of gravity. With these forces at work, the muscles that keep the forehead smooth grow weaker, which allows for deep wrinkles to set it.
To further produce a more youthful appearance, forehead lifts are commonly combined with eyelid surgery in a effort to reduce the sagging skin of the upper eyelids.
Correction of a wrinkled forehead usually leads to a more youthful look. Also, prior to surgery, your tired, angry, or sad expression may not have reflected how you actually felt, at the time. Addressing the incorrect projection of emotions can lead to more positive and productive business and social interactions between friends, family and work colleagues.
Types of Forehead Lift Procedures:
Multiple surgical approaches can be utilized in forehead lift procedures. They include:
Direct Brow Lift: This procedure begins with removing a half-moon shape of skin and muscle, above the eyebrows. Neither lines nor wrinkles are addressed in the direct brow lift, which means scars will be apparent. This procedure caters to much older patients or men who have thick, unruly eyebrow hair and, potentially, male pattern baldness.
Mid-forehead Lift: This procedure is for patients over 65, with very deep forehead wrinkles and heavy, sagging eyebrows. Excess fat, muscle and skin tissue are removed during the procedure.
Coronal Forehead Lift: Started with an ear to ear cut that runs across the top of the scalp, the entire brow and forehead are elevated.
Endoscopic Forehead Lift: One of the most current techniques, this forehead lift requires a surgical telescope in order to raise the brow. Forehead wrinkles are smoothed out by small incisions which are made beneath the hairline.
Endotine ™ Brow Lift: is a recent alternative to a traditional forehead lift. Unlike traditional brow lifts, the Endotine™ Brow Lift only requires a single incision along the upper eyelid of each eye. A forehead implant is then secured and the incision is finely sutured.
Patients requesting a brow lift procedure commonly range in age from 40 to 60, with brow lines and eyelids that have begun to sag noticeably. Wrinkles or creases have also begun to appear along the forehead. However, hereditary causes can sometimes make these problems an issue for people in their 20s and 30s. In these cases, a brow lift can also help.
Candidates for this procedure should be in good physical health, be psychologically stable, are non-smokers (or able to stop before and during the healing process) and have a thorough understanding and realistic expectations of what the brow lift procedure can and cannot accomplish. After an in-depth discussion with an experienced cosmetic surgeon, some decide that a brow lift performed in conjunction with other procedures (e.g., a face lift or eyelid surgery) will provide the best results.
In some cases, brow lift patients initially believe they need eyelid surgery to correct drooping above the eyes. After a consultation with a cosmetic surgeon, they discover that a brow lift will address their problems more effectively.
Direct Brow Lift:
The procedure is, as follows: the surgeon makes the appropriate marks (with a marking pen – at several locations) along the full length of the brow border at the hairline. This is done with the brow in its’ original position and then, pulled up to its’ intended post-operative position. The line of these additional marks is then joined to the original mark to form an ellipse.
The surgeon then identifies the position of the supraorbital (above the eye) nerve and vessels and makes an incision along the marked ellipse, staying within the subcutaneous fat layer to protect the supraorbital nerve and vessels. Excess tissue is then removed within the ellipse.
Afterwards, the wound is sutured in two layers. Steri-strip™ dressings are placed along the wound and the ends of the skin closure are also taped under a further layer of Steri-strips™. Sutures and Steri-strips™ are removed in 5–7 days.
A mid-forehead lift is designated for patients 65 years and older who have heavy drooping eyebrows and the deepest forehead wrinkles. Initially, the procedure is the same as a Direct Brow Lift. The surgeon will make preparations by using a marking pen to outline the area of the surgical procedure. Anesthesia is administered intravenously in order to provide supraorbital (above the eye) nerve blocks. More injections are given along the incision line, over the brow and glabellar (between the eyebrows) regions.
An adequate anesthetic effect is achieved in 10-15 minutes. Then, incisions are made within the forehead wrinkles and the excess skin, fat, and muscle tissues are removed. This is done so that the incisions created in the deep wrinkles are hidden once the patient reaches the end of recovery. The area is then stitched up (sutured) in two layers and Steri-strips™ are applied. The surgeon may also apply a Velcro® forehead dressing, as well. Sutures and Steri-strips™ are removed in 5–7 days.
Coronal Forehead Lift:
This procedure is the oldest brow lift technique and is considered, by many surgeons, to be the most reliable. The surgery utilizes an incision across the top of your head, from ear to ear (also known as a “headband incision”). Through this incision, the surgeon then alters the muscles that cause horizontal forehead wrinkles and frowning. After accomplishing this, the surgeon will then remove about a 1-2 cm strip of your scalp and sew the remaining scalp together.
The main disadvantage to a coronal forehead lift is numbness on the top of the head for about six months, after which time the sensation usually returns. This technique also raises your hairline, which can be a problem for those with a high forehead who also wear their hair back.
The advantages of the coronal forehead lift technique are that it will not have to be repeated as you age (with very rare exceptions). Also the scars are concealed behind the hairline (unless you are a man with a receding hairline, in which case you should not have this kind of brow lift, unless you plan on wearing a toupée).
These days, the coronal brow lift has been mostly replaced by other brow lift techniques (such as the endoscopic brow lift), but in some cases, a coronal brow lift is still the most effective way to address the patient’s needs and provide the best results.
Endoscopic Forehead Lift:
For this procedure, the surgeon will first place the patient in an upright sitting position. The desired forehead elevation is then determined by manually raising the brow to the desired position. At that point, a marking pen is used while letting the brow drop (with gravity) while holding the pen on the skin. Marks are made in two places (medially and laterally) on the skin to measure the desired amount of brow elevation.
Anesthesia is then administered using either general anesthesia or local anesthesia with conscious sedation. The type of anesthesia used will depend on the patient’s and surgeon’s preference. If local anesthesia with sedation is used, supraorbital (above the eye) nerve blocks and various other brow locations are anesthetized first, while a general light sedation of the patient is accomplished. A ring nerve block of the scalp may also be performed, but this is seldom necessary.
After the anesthesia has taken effect, small incisions are made and an endoscope (a medical device consisting of a long, thin tube which has a light and a video camera) is placed under the skin. This is done in order to get a clear view of the muscles and tissues underneath the skin. Then the surgeon inserts another instrument through a separate incision to lift the forehead skin and remove or alter the muscles and underlying tissues. The forehead skin is then fixed to a higher position with temporary screws. The skin will heal in this position and remain there after the screws are removed.
It should be noted, though, that when surgeons have problems with an endoscopic forehead lift, — in about one percent of cases — they may have to finish the procedure by switching to the open forehead lift method. This will result in a more extensive scar and a longer recovery period.
Endotine ™ Brow Lift:
This technique uses a small, pencil-like camera device connected to a television monitor. The endoscope is inserted into several small, one-half inch to one-inch incisions placed just behind the hairline, providing the surgeon with a clear view of the muscles and tissues beneath the skin. The surgeon then inserts another instrument through one of the small incisions to lift the skin and remove or alter muscle, if necessary.
During an endoscopic procedure, the eyebrows and forehead will be lifted and secured at the optimal height through the use of a suture-less mechanism called the Endotine™ Forehead Fixation Device. The Endotine™ Forehead Fixation Device is soft tissue device that holds the facial adjustment while the body heals. It uses a bio-absorbable implant which dissolves into the body in about six to twelve months.
Recovery times vary and are dependent of the procedure and should be discussed with your doctor. But, in general:
You will need to keep your head elevated for 2 to 3 days after surgery. This will help to reduce swelling. You will be able to shower and shampoo your hair within two days, or as soon as the bandage is removed. If your job does not involve physical activity, you will probably be able to return to work within 7 to 10 days after a conventional forehead lift. Sooner, after an endoscopic forehead lift procedure.
Recovery for a conventional forehead lift:
After surgery, you may experience some numbness and discomfort around the incision. Your doctor can prescribe medication to relieve the discomfort. If you are prone to headaches, your doctor may give an additional local anesthetic during surgery as a preventive measure. There will be some swelling that may extend to the cheeks and eyes and should abate within 10 to 14 days. As the nerves begin to heal, the numbness may be replaced by itching.
Recovery for an endoscopic forehead lift:
After this procedure, you may experience some numbness, incision discomfort and mild swelling. Incision site pain is usually minimal and can be controlled with medication, if necessary. Endoscopic forehead lift patients usually experience less pain and itching than those who have had a conventional forehead lift. The stitches or staples used to close the incisions are usually removed within one week, and the temporary fixation screws are removed within two weeks.
Risks Associated With Brow Lift Surgery:
As with any surgery, infection and bleeding are possible. Infection is treated with prescribed antibiotics.
When performed by a board certified and/or qualified surgeon who is trained in these special techniques, complications from forehead lift surgery are relatively rare and minor. In some cases, a broad scar may form after surgery and additional surgery may correct the problem. Rarely, the surgical process may result in nerve damage which causes loss of eyebrow control and forehead movement. Additional surgery may also correct this problem. Incisions cut through the hairline could also result in hair loss along the scar.
Patients with Endotine™ implants in their foreheads are at risk of moving their tissues, which are still newly adjusted, with relatively tiny motions immediately following forehead lift surgery and before healing is fully completed. Thick forehead flesh and heavy brows, which are most commonly found in overweight males, are not fully supported by the Endotine™–even though the implant is absorbed into the body.
As mentioned earlier, if a complication should occur during an endoscopic forehead lift, your surgeon may have to use the conventional, open procedure, which will result in a more extensive scar and a longer recovery period. Such complications are estimated at less than 1 percent of all endoscopy procedures.
The average cost of a brow lift is about $3,000*, but can range from $2,000 to $8,000. Doctors with less experience may charge a reduced amount for the procedure, so be sure to ask your surgeon how many brow lift surgeries he or she has performed. You should not allow your concern for the cost to override your concern for your safety. If you are undergoing other procedures in conjunction with your brow lift, this will affect the overall cost. You should be aware, in advance of your surgery, of all procedural costs (including anesthesia and facility costs).
Endoscopic forehead procedures cost about as much as a traditional brow lift. However, the endoscopic surgery may be considered a more economical option because there is a shorter recovery time, allowing you to return to work sooner. The endoscopic technique should also require less follow-up care, and fewer medications to control post-operative discomfort.
You should note, though, that the endoscopic brow lift is a newer procedure and some surgeons may have more experience performing these types of surgeries than others. You should ask your surgeon exactly how many he or she has performed.
Most healthcare insurance companies will not finance this type of surgery unless there is a medical concern (for example, when drooping affects vision). You need to check with your insurance company regarding their policies. However, most doctors provide various financing options in order to make the procedure(s) more affordable.
* The national average of 2007 surgeon fees for forehead lift was $3,092(Source: American Society of Plastic Surgeons).
New England states: $3,255
Middle Atlantic States: $2,630
North Central states: $3,148
South Central states: $2,797
Mountain/Pacific states: $2,846.
Anesthesia, operating room facility, hospital stay, and other related expenses are not included in these figures.
10 Questions to Ask Your Doctor Regarding Brow Lift Surgery:
- Will a Forehead Lift remove fine lines? What are my reasonable expectations?
- What are the differences between Laser Resurfacing, Dermabrasion Removal and Brow Surgery?
- How long does the effect of a Forehead Lift last?
- What are the non-surgical options to a Forehead Lift?
- Does a Forehead Lift/ Brow Lift “Freeze your Face”?
- How long does a Forehead Lift take?
- What type of anesthesia will be used?
- Can a Forehead Lift be combined with other procedures? If so, which procedures?
- What risks/complications are possible and how often do you experience them in your practice?
- How many Forehead Lift procedures have you performed?