Fore Head Lift (Brow Lift)

    A brow lift, or forehead lift, is a surgical procedure that smoothes out the forehead, while raising the upper eyelids and reducing frown lines. The procedure is one of the least complicated and least painful of all cosmetic surgeries. A forehead lift erases many of the effects of aging, leaving you with a smoother, more youthful looking appearance

    Someone is a candidate for the process

• Low or sagging eyebrows that may result in a tired or sad appearance.
• Eyebrows low enough to cause redundant tissue of the upper eyelids (this hooding of eyelid skin can sometimes interfere with raising the upper eyelids.
• Deep horizontal creases in the forehead.
• Frown lines or vertical furrows between the eyebrows or across the top of the nose which may make you look angry and upset.

    Brow lift surgery can help all of these problems. Any one or a combination of these problems can mean that brow lift surgery should be considered. It sometimes is done in conjunction with facelift surgery (rhytidectomy) and or eyelid surgery (blepharoplasty). Those who are bald, have a receding hairline, or prior upper eyelid surgery may still be good candidates. Surgical options depend on scars and other factors. Remember, a brow lift can enhance your appearance and self confidence. It is surgical sculpture and has its limitations. The surgery will not cause people to treat you differently. If you have unrealistic expectations, you will not be happy.
    To see what a forehead lift may offer, stand in front of a mirror. Place your hands on the outer edges of the eyes above the brows. Gently pull the skin up to raise the eye brows and forehead. This is a rough approximation of what a brow lift has to offer.

    Pre-Operative Care

    Several choices need to be made about the type of browlift to be done. In patients with good skin elasticity, an endoscopic brow lift can often be performed. This operation makes three to five small incisions in the hairline, then releases and pulls the brows up. The scars are very small and hidden in the hair and your hairline shifts minimally. Frown lines and wrinkles of the forehead and brows can also be treated through the endoscopic approach.
    When skin needs to be cut away, there are three standard approaches: a temporal brow lift with two small hairline incisions; an anterior hairline brow lift with one longer hairline incision; and a coronal incision over the top of the head. 
    No aspirin, ibuprofen, or similar drugs should be taken within two weeks of surgery. These medications can cause serious excess bleeding during, and after, the operation. If you have any questions about drugs you are taking, including over the counter preparations and natural herbs, please call the pharmacist or doctor.
    If you are a smoker you will be advised to stop smoking prior to surgery in order to prevent unnecessary complications.
    Arnica tablets, vitamin E in large doses, analgesics like Aspirin and even some anti-inflammatory drugs should also not be taken prior to surgery as they can promote bleeding during the procedure.

    The Operation

    As mentioned above, there are several types of brow lifts:

• The endoscopic brow lift involves three to five small incisions in the hairline through which a small camera and specialized instruments are inserted to lift the brow. Overactive forehead and brow muscles can also be removed through this approach to reduce wrinkles. Once the skin is closed there may be a small bump over the incision area which dissipates over one to two months.
• The temporal brow lift involves two diamond shape excisions placed carefully at the hairline on either side of the forehead. The skin between the excision and the brow is carefully lifted and the extra skin is cut away. Drains are usually placed to prevent fluid collections and the skin is closed. Advantages of this approach are the well-hidden scars and minimal numbness of the forehead and scalp.
• The anterior hairline brow lift involves an incision placed along the entire hairline of the forehead. The skin of the forehead is raised in a fashion similar to a facelift and the extra skin is removed. In most cases a drain is placed to prevent collections of fluid. An advantage of this approach is that the hairline is not raised or lowered significantly. A disadvantage of this approach is a potentially noticeable scar depending on how you wear your hair and how your body tends to scar.
• A coronal brow lift involves an incision across the top of the head in the hair-bearing scalp. The skin from the incision forward to the brows is lifted and pulled backward. The extra skin is cut away and the wound is closed, sometimes with a drain. The advantage of this approach is a sturdy and significant elevation of the brows. A disadvantage of this approach is possible raising of the hairline; therefore, it is best performed on people with low preoperative hairlines. Numbness of the scalp and a potentially noticeable scar if hair follicles are lost during the operation, are other possible disadvantages to this approach.

    At the conclusion of surgery, a compressive dressing is applied to decrease fluid collections. A cold pack may also be applied to the eyes to decrease swelling.

    Post-Operative Care

    In most cases, the brow lift is performed in conjunction with other surgery and a one night hospitalization will be required. Temporal lifts can be done in the office and you can go home several hours after the surgery.
    Physical exertion and lifting should be kept to a minimum for 7 to 10 days. Bruising may last for 2 to 4 weeks but can be covered with makeup.
    Specific Post Operative Instructions
  1. You may shampoo your hair as soon as 24 hours after surgery. Because of the decreased sensation that often occurs in this area, use warm rather than hot water, and gently use your fingertips. You may touch the staples, but do not pull or remove them. If you use a hair dryer, use the lowest heat setting.
  2. The Doctors will remove your dressings the day after surgery.
  3. Keeping the head elevated helps reduce swelling and discomfort.
  4. We will remove the sutures or staples approximately 10 days after surgery.
  5. If you have thin hair, protect your scar from sun exposure for at least   6 months after surgery. Remember to wear a hat or sunscreen with a skin- protection factor (SPF) of at least 15 whenever you go outside.
  7. No heavy lifting, straining or aerobic exercise for 2-3 weeks. You may continue the activities of daily living as you feel comfortable.
  8. If postoperative oozing occurs under your forehead flap, some swelling and bruising may develop in the upper eyelids or around the eyes. This will usually resolve within 2 weeks.
  9. Beware of bumping your head. The decreased sensation that often occurs in this area may make you temporarily unaware of an injury.