Forehead Lift (Brow Lift)

What is a Forehead Lift?

A forehead lift is a plastic surgery procedure that corrects skin that sags from the eyebrows, upper eyelids or forehead. Brow lifting can be done endoscopically or via the more traditional open approach. It may be done in conjunction with other procedures such as a facelift, eyelid surgery (see blepharoplasty), or nose reshaping.

At the Division of Facial Plastic Surgery, Department of Otolaryngology, we usually perform this procedure on an outpatient basis although in rare cases, an overnight stay may be required.

How is a Forehead Lift Done?

Local anesthesia and a sedative are typically administered to numb the forehead and relax the patient. As a result, the patient is awake but insensitive to pain.

Because the procedure requires some stretching of the forehead, occasional discomfort may be felt. If a patient is concerned about the possibility of pain, he or she should ask the doctor about the use of general anesthesia, which will allow them to sleep through the procedure.

Historically, the procedure was done by making an ear to ear incision around the forehead just above the hairline. The forehead skin was measured to determine the amount that needs to be removed for best aesthetics results. After the extra skin and/ or muscle was removed, the incision was closed with either sutures (stitches) or staples. Then the patient would have his or her surgical wound bandaged to help protect the wound and prevent infection. The procedure is now performed endoscopically to minimize discomfort.

Endoscopic Forehead Lift (Endobrow)

In contrast to the traditional procedure, endoscopic procedures can avoid the long incision along the entire hairline. Instead, a series of about five tiny incisions are placed above the hairline, in the scalp, through which tiny instruments are inserted. An endoscope, which is a small camera, is inserted through one of these incisions (much like in orthoscopic knee surgery). Small instruments are passed through the other incisions. The endoscopic camera allows for visualization of the tissues under the skin. Through the incisions, the surgeon frees the tissues of the forehead and elevates them to a more youthful looking level. Two very tiny, permanent or absorbable anchors are then placed that will hold this new position.

Who Can Benefit From a Forehead Lift?

The procedure is most commonly done on people who are 40 to 60 years of age who wish to slow the visible signs of aging. Many patients who are concerned about fullness of the upper eyelids can in fact benefit from an endobrow lift. While some physicians prefer to perform eyelid surgery separately from a brow lift, our experience is that it is both safe and advantageous to the patient to perform both at the same time.

Forehead lift surgery may also be appropriate for others who have conditions such as:

burrowed brows above the nose
droopy eyebrows
low eyebrows that give people a "sad" expression
sagging eyebrows that are so low that they interfere with vision
skin that hangs down the outer part of the eyebrows
horizontal wrinkling on the forehead
deep furrows between the eyes
patients with sagging brow due to facial paralysis or stroke

Risks of Forehead Lift Surgery

Complications associated with forehead lift surgery include:

weakening in nearby nerves
Bleeding or hematoma (pooling of blood at the surgical site)
Seroma (collection of fluid at the surgical site)

Such complications are extremely rare, and most patients recover uneventfully.

How Long Does It Take To Recuperate From A Forehead Lift?

After a forehead lift, patients will be able to walk around in a day or two. However, they will not be able to do work for at least 7 to 10 days after surgery. In the meantime, patients will most likely feel numbness and temporary discomfort at the site of surgery, which can be controlled with medication. Additionally, to limit inevitable bruising and swelling around the cheeks and eyes, patients will need to elevate their head when they lay down for 2 for 3 days after surgery.

Then, typically within 10 days, patients will be able to return to work or school. Next, as the recovery process continues, numbness in the forehead and scalp may be replaced with itchiness, which is an indication that a patient's sensory nerves are recovering (regenerating) from surgery.

Within the next 2 to 3 months, the most visible signs of surgery should completely fade. In the meantime, camouflage make-up can cover minor swelling and bruising.

What Are The Long-Term Benefits Of Forehead Lift Surgery?

Most patients who undergo forehead lift surgery are pleased with the results and appear much younger and more rested. Since the aging process continues, the effects of the surgery will diminish as the years pass, just like after any other cosmetic procedure.

Risks Associated with Forehead Lift Surgery

Cigarette smokers are at risk for poor scarring during or shortly after forehead lift surgery. This possibility exists because the nicotine and carbon monoxide in tobacco smoke limit the amount of oxygen needed to properly heal all of the skin affected by surgery. Plastic surgery facial wounds may not heal properly in approximately one in ten smokers.

With this in mind, patients can help themselves heal satisfactorily and quickly if they avoid smoking for two to four weeks prior to surgery and a month after surgery. Other risks include uncontrolled blood pressure, blood-clotting problems, and the tendency to form excessive scars.