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Forehead Lift New York Metro Area
All surgery carries some uncertainty and risk
If you’re considering a forehead / brow lift
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. Weinstein 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 brochure 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 your doctor if there is anything you don’t understand about the procedure.
A forehead lift can smooth the forehead, raise the upper eyelids, and minimize the frown lines that come with aging.( see before and after photos of 44 year old female #2801, 46 year olds #2802 / 2783, 49 year old female #2769).
The best candidates for a forehead / brow lift
A forehead lift is most commonly performed in the 40-60 age range to minimize the visible effects of aging from brow ptosis, hooding of the brows, excess skin of the lower forehead, excess skin of the temples, visual field loss from severe eyelid/brow ptosis, severe wrinkles above the eyebrows and asymmetry of the brows. 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 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. Dr. Weinstein 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 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 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, 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. Weinstein 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. Weinstein’s instructions both before and after 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 a plastic surgeon, he 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, such as uncontrolled high blood pressure, blood-clotting problems, or the tendency to develop large scars. Be sure to tell the surgeon 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. Weinstein 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 those regarding your expectations and concerns about the results of surgery.( see before and after photos of 44 year old female #2801, 46 year olds #2802 / 2783, 49 year old female #2769).
Dr. Weinstein 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. Weinstein 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. Weinstein recommends and why he feels it is best for you.
Most forehead or brow lifts by board certified plastic surgeon are done with two small inconspicuous incisions above or at the hairline using dissolvable Endotines.
The ENDOTINE Forehead device is designed to help distribute tension and reduce areas of high stress, providing Dr. Weinstein with greater aesthetic control of your brow height and shape. These tiny incisions are closed with fine sutures and are rarely visible. The Endotines dissolve over six months and form scar tissue which helps maintain the lift. The muscles that cause 11 lines in the forehead can be weakened through these tiny incisions. Botox or Dysport may still be used to control the anger lines.
Dr. Weinstein rarely uses the old classic forehead lift: Before the operation begins, your hair was 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 be greased back with Bacitracin ointment.
For rare 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. I commonly recommend the hairline incision to those women or men with receding hair lines that would benefit from a their hairlines being brought forward. 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 themselves as well to incision coverage.
If you are bald or have thinning hair, Dr. Weinstein may rarely 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.
In preparation for a forehead lift, the hair is tied back with rubber bands in front of and behind the incision area. An incision is usually made across the top of the head, just behind the hairline.
Forehead skin is gently lifted and portions of facial muscle and excess skin are sometimes removed. The incision is then closed with stitches or clips. When using the Endotine dissolvable plates the skin and muscle is repositioned not removed.
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, rather than making one long coronal incision, Dr. Weinstein will make three, four or two 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 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 Dr. Weinstein’s preference.
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.
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.
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.
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.
The result of a forehead lift is a younger, more rested 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.
Correction of the High Female Hairline
Alexander L. Ramirez, MD; Kevin H. Ende, MD; Sheldon S. Kabaker, MD
Arch Facial Plast Surg. 2009;11(2):84-90.
Objectives:
To review a technique and to make quantitative analyses of the senior author’s 20-year experience with his preferred technique to correct the high female hairline.
Methods A retrospective review of 29 female patients who underwent the hairline-lowering procedure performed by the same surgeon (S.S.K.). We analyzed preoperative and postoperative standardized photographs by taking measurements from the medial and lateral canthi to the anterior hairline. Facial height, from the menton to the hairline, was also measured. We calculated mean values and then used a 2-tailed, paired t test to evaluate for statistical significance. Patients also underwent evaluation for satisfaction, complications, and aesthetic result. We reevaluated the measurements from the profile view and compared them with the original data.
Results:
The photographed midfrontal hairline position was vertically lowered on average 1.3 cm in patients who underwent a single-stage procedure (P < .001). In retrospect, the analysis was flawed compared with clinical experience. Therefore, the profile views were evaluated, and the correlating true curvilinear advancement was an average of 2.1 cm. Three complications occurred, including 1 major effluvium, 1 minor effluvium, and 1 scar that required revision. Patient satisfaction was extremely high.
Conclusions:
Advancement of the female hairline by incorporating an irregular trichophytic incision and a posterior scalp advancement flap is an effective and safe technique that has been used by the senior author for more than 2 decades. The average advancement was 2.1 cm in this study. The technique is immediately effective, well tolerated by patients, and associated with minimal complications. Although it is associated with a potentially visible incision, this technique can be used to make the scar virtually invisible.Note: This is one of the alternatives I use for brow lifting, hooded eyelids or high hairline corrections. In the past 20 years with very natural results.