If you're considering a forehead 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. 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 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.
THE BEST CANDIDATES FOR A FOREHEAD LIFT
A forehead lift is most commonly performed in the 40-60 age 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 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 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,
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 percent of all endoscopy procedures.
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 a plastic surgeon, he or she 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, your surgeon 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.
PREPARING FOR YOUR SURGERY
Your surgeon 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.
THE SURGERY
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. Make sure you understand the technique that
your surgeon recommends and why he or she 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 themselves as well to incision coverage.
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: the hair is 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 screws 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.
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.
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 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 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.
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.
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