If you are considering a forehead lift or 'browlift' there may be some questions you would like answered. You may choose to undergo a forehead lift for any of the following reasons:
- To restore a more youthful, refreshed look to the area above the eyes
- To correct drooping brows
- To improve horizontal lines and furrows that make you 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 minimise frown lines. Your LPSA surgeon may use the conventional surgical method - in which the incision is hidden just behind the hairline - or may perform the lift with the use of an endoscope, a viewing instrument that allows the procedure to be performed with minimal incisions. Both techniques yield similar results of smoother forehead skin and a more youthful appearance.
If you are considering a forehead lift, the following frequently asked questions and answers (FAQs) will help to provide a basic understanding of the procedure - when it can help, how it is performed and what results you can expect. These may not answer all of your questions, since a lot depends on your individual circumstances, but your doctor will be able to help you with any further concerns you may have about the procedure.
What should I consider before having a forehead lift?
If you are between 40 to 60 years old, a forehead lift can help to minimise the visible effects of ageing. 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 face lift 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 of 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 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 surgeon at LPSA.
How do I plan my forehead or brow lift?
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.
Your plastic surgeon at LPSA will first evaluate your face, including the skin and underlying bone. During your consultation, the surgeon will discuss your goals for the surgery and ask you about certain medical conditions that could cause problems during or after the procedure. Be sure to tell the surgeon if you have had previous facial surgery, if you smoke, or if you take any medications.
If you decide to proceed with a forehead lift, your surgeon will explain the surgical technique, the recommended type of anaesthesia, the hospital where the surgery will be performed and the costs involved. Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results of surgery.
How do I prepare for surgery?
Your surgeon will give you instructions to help you prepare for surgery. These may include guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.
While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed. 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.
Where will my forehead lift be performed?
The surgery is performed at one of several of London's best private hospitals, according to your preference and the availability of operating time.
You will usually be admitted on the morning of surgery, and stay until the early evening. Occasionally, an overnight stay will be indicated. You will need a friend or relative to accompany you home after your stay in the hospital.
What type of anaesthetic will be used?
Most forehead lifts at LPSA are performed under general anaesthetic, so you'll sleep through the entire operation. Newer types of intravenous anaesthesia are used at LPSA, which reduce the risk of sickness after surgery.
What takes place during the surgery?
You'll probably wish to discuss the pros and cons of the surgery with your LPSA surgeon beforehand to make sure you fully understand the implications of the procedure he recommends for you. 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.
The classic forehead lift
Before the operation begins, your hair will be tied up 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 curvilinear, 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 naturally cover the incision.
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 steps as the traditional procedure, and the hair is also tied back and trimmed behind 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 their higher position by sutures beneath the skin's surface or by temporary fixation devices (Endotines) placed behind the hairline.
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.
What can I expect after my 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 anaesthesia 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 but 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 devices are usually fully resorbed within nine months.
How long will it take for life to return 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.
How will I feel about my new look?
Most patients are pleased with the results of a forehead lift, no matter which surgical method was used. Often, patients don't realise 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 minimise the appearance of ageing for years. As time passes, you may wish to repeat the procedure.
Does a forehead lift carry any risk?
Complications are rare and usually minor when a forehead lift is performed by a qualified LPSA plastic surgeon. However, it is important to consider the possibility of complications. By closely following your surgeon's instructions both before and after surgery you can reduce your risk of complications.
In extremely rare cases, it has been reported in the literature that 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 therefore 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, but may be permanent in some patients.
Infection and bleeding are very rare, but are possibilities. Minor asymmetries in brow position may persist after surgery.
If a complication should occur during an endoscopic forehead lift, your surgeon 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% of all endoscopy procedures.