A forehead lift is a cosmetic surgery procedure intended to improve a person's appearance by correcting the shape of the eyebrows and reducing horizontal wrinkles or furrows in the skin of the forehead. It is also known as a brow lift.
The purpose of a forehead lift is improvement of the patient's external appearance, particularly with regard to the upper third of the face. Some people have clearly marked frown lines or drooping of the eyebrows or eyelid caused by loosening of the tissues and muscles around the eyes during the aging process. The drooping of the eyelid is sometimes referred to as ptosis, which comes from a Greek word meaning "fall." In some cases, these signs of aging make the person look angry, anxious, or sad. A forehead lift is not done to cure disease or repair a major wound or injury.
Like other cosmetic surgery procedures, forehead lifts are performed much more frequently than they were
Most plastic surgeons recommend that a forehead lift should be done when the patient is between 40 and 60 years old, although it is sometimes done on younger patients who have very deep frown lines due to stress or have inherited very low and heavy brows. In addition, people whose facial skin has aged prematurely due to sun exposure or heavy smoking may be candidates for a forehead lift in their mid-30s. In 2002, the average age of patients of either sex who had forehead lifts done in the United States was 47.
Statistics published by the American Academy of Cosmetic Surgery (AACS) in January 2003 indicate that although more men are choosing to have cosmetic surgery than in the past, the female:male ratio for forehead lifts is still 6:1. In 2002, surgeons who are AACS members performed 7,882 forehead lifts on women compared to 1,139 procedures on men. Forehead lifts account for a little less than 1% (0.96%) of all cosmetic surgery procedures performed each year in the United States and Canada.
Although most forehead lifts and other facial cosmetic procedures are still performed on Caucasian patients, this type of surgery is gaining rapidly in popularity among Hispanics, Asian Americans, and African Americans. Between 1999 and 2002, the proportion of cosmetic procedures performed on Hispanics has increased by 200%, on African Americans by 323%, and on Asian Americans by 340%. As of 2003, Caucasians account for only 77% of patients having elective facial surgery, compared to 83% in 1999.
There are two main types of forehead lifts. The classic, or open, forehead lift involves a long incision along the top of the forehead and lifting of the skin of the forehead. The second type of forehead lift, known as an endoscopic lift, is performed with special instruments inserted through four or five small incisions behind the hairline.
Classic forehead lift
Aftercare for a classic forehead lift is somewhat more complicated than for an endoscopic procedure. Pain or numbness around the incision is likely to last longer than for an endoscopic procedure. It is controlled with prescription medication. Patients are usually advised to keep the head elevated for two to three days after surgery to minimize swelling. Bandages are removed a day or two after the procedure; stitches or staples are taken out between 10 days and two weeks after surgery. The patient is asked to rest quietly for one or two days after surgery. Most patients can return to work after a week or 10 days.
Endoscopic forehead lift
Fixation devices around the eyebrows are usually removed within 10 days after endoscopic surgery. As of early 2003, however, new absorbable fixation tacks that do not require later removal are being used with good results.
Patients who have had either type of forehead lift should not wash their hair until the bandage or dressing is removed, usually within two days. Heavy lifting, vigorous athletic activity, sexual activity, or any type of exertion that raises the blood pressure should be avoided for five to six weeks after the surgery. The skin around the incision should be protected from direct exposure to the sun for at least six months, because the new tissue is much more vulnerable to sunburn than normal skin. Most surgeons advise patients to use a sunblock cream to protect the skin even after the first six months.
Patients can use a special camouflage makeup to cover the bruising or swelling that often occurs after surgery, although they should be careful to keep the makeup away from the incision. Most of the bruising and other signs of surgery will fade within about three weeks.
It is somewhat misleading to speak of diagnosis on the context of forehead lifts and similar procedures because cosmetic surgery is unique in one respect—it is the only type of surgery in which the patient initiates "treatment" rather than the doctor. This difference means that many plastic surgeons now screen patients for psychological stability as well as general physical fitness for surgery. Beginning in the 1970s and 1980s, psychiatrists began to see patients who were obsessed with a particular facial feature or other small part of their body, as distinct from overconcern about weight or general body shape. This condition, which is now called body dysmorphic disorder (BDD), became an official psychiatric diagnostic category in 1987. Patients with BDD frequently seek plastic surgery as a solution for their dissatisfaction with their looks. In many cases, however, the "flaw" that the patient sees in his or her face is either exaggerated or nonexistent. Ironically, although men are less likely than women to request facial surgery, a higher percentage of male cosmetic surgery patients are emotionally disturbed; one survey of plastic surgeons estimated that six out of every 100 female patients and seven out of every 100 male patients meet the diagnostic criteria for BDD.
When a person consults a plastic surgeon about a forehead lift or similar procedure, the doctor will spend some time talking with the patient about his or her motives for facial surgery as well as taking a general medical and surgical history. Good candidates for facial surgery are people who have a realistic understanding of the risks as well as the benefits of this type of surgery, and equally realistic expectations of the outcome. On the other hand, the following are considered psychological warning signs:
- The patient is considering surgery to please someone else, most often a spouse or partner.
- The patient expects facial surgery to guarantee career advancement.
- The patient has a history of multiple cosmetic procedures and/or complaints about previous surgeons.
- The patient thinks that the surgery will solve all his or her life problems.
- The patient has an unrealistic notion of what he or she will look like after surgery.
- The patient seems otherwise emotionally unstable.
If the surgeon thinks that the patient is a good candidate in terms of motivation, he or she will continue the diagnostic assessment by examining the patient's face at close range. To make an initial evaluation of the possible results of a forehead lift, the surgeon will gently lift the skin at the outer edges of the eyes above the brows in an upward direction. He or she may also ask the patient to look in a mirror and describe what they don't like about their face. Next, the surgeon will ask the patient to frown, smile, or make a variety of other facial expressions. This technique allows the surgeon to observe the activity of the patient's facial muscles. Depending on the amount of loose skin in the upper eyelid, the height of the patient's hairline, and the relative position of the eyebrows, the surgeon may recommend a blepharoplasty or other procedure instead of a forehead lift.
Preparation for a forehead lift involves practical as well as medical concerns.
FINANCIAL CONSIDERATIONS. Most cosmetic facial procedures are not covered by health insurance because they are regarded as nonessential elective procedures. As a result, many cosmetic surgeons request that fees be paid in full before the operation. According to the AACS, 13.4% of cosmetic surgery patients take out loans to finance their procedure. In 2002, the average cost of a forehead lift was $3300.
MEDICAL AND HOME CARE ISSUES. A patient scheduled for a forehead lift will be asked to prepare for the operation by quitting smoking and discontinuing aspirin or any other medications that thin the blood. The surgeon will ask for a list of all medications that the patient is taking, including alternative herbal preparations as well as prescription drugs, to make sure that there will be no interactions with the anesthetic.
Patients are advised to have someone drive them home after the procedure and help them with routine chores for a day or two. If the forehead lift is combined with a face lift or blepharoplasty, the surgeon may have the patient remain in the hospital overnight. Although
Major complications of a forehead lift are unusual. The most common risks from the procedure are as follows:
- Headaches for a day or two after surgery. This complication is much more common with a classic forehead lift than with endoscopic surgery.
- Mild pain around the incision for a few days after surgery.
- Numbness or itching sensations on the top of the scalp. These may last for as long as six months after surgery.
- Mild bruising or swelling around the eyelids and cheeks.
- Hair loss or thinning in the area of the incision. The hair will usually regrow within a few weeks or months.
- A feeling of numbness or dryness in the eye.
- Loss of function of the eyelid. This complication is corrected by another operation.
- Bleeding or infection. These are rare complications with forehead lifts.
Normal results of a forehead lift are an improvement in appearance that is satisfying to the patient. Specifically, the forehead should look less creased or wrinkled and frown lines should be lighter. The cosmetic effects of a forehead lift last between five and 10 years, depending on the person's age and the condition of their skin when the procedure was performed.
Morbidity and mortality rates
In general, mortality and morbidity rates for forehead lifts and similar facial cosmetic procedures are very low. Almost all cases of mortality following facial cosmetic surgery involve patients who were treated for facial disfigurement because they had been severely burned or attacked by animals. Moreover, many plastic surgeons do not consider morbidity and mortality rates to be as significant as other factors in evaluating the success of facial cosmetic procedures. One group of researchers at the University of Washington maintains that "[t]he most important measures of outcome in facial cosmetic surgery are quality of life and patient satisfaction,
Several American studies have reported that the rate of complications is no higher when a forehead lift is done in combination with other facial procedures than when it is done by itself.
Soft tissue fillers
Alternatives to surgical treatment for frown lines and wrinkles of the forehead include injections of filler materials under the skin to smooth wrinkles or injections of botulinum toxin to paralyze the facial muscles involved in frowning or brow wrinkling. The most commonly used filler materials are collagen and fat. Collagen is a protein found in human and animal connective tissue that makes the tissue strong and flexible. Most collagen that is used for cosmetic injections is derived from cattle, which produces allergic reactions in some people. Fat injections use fat taken from the patient's abdomen, thighs, or buttocks. The fat is then reinjected under the skin of the forehead to smooth out lines and wrinkles.
One drawback of both collagen and fat injections is that the effects are not permanent. Some new injectable filler substances are said to be permanent wrinkle removers. They include Artecoll, which contains small plastic particles that supposedly stimulate the body to produce its own collagen; and Radiance, which is made of a chemical called calcium hydroxylapatite. Still other injectable tissue fillers are made from synthetic hyaluronic acid, which has been used for a number of years to treat joint pain. Since hyaluronic acid is produced naturally in the body, allergic reactions to this type of tissue filler are relatively rare.
Botulinum toxin is a compound produced by the spores and growing cells of the organism that causes botulism, Clostridium botulinum. The toxin causes muscle paralysis. It was first used clinically in the 1960s to treat neurological disorders but also proved to be effective in paralyzing the facial muscles that cause "crow's feet" and frown wrinkles. Botulinum toxin, or Botox, was approved by the Food and Drug Administration (FDA) in April 2002 as a treatment for facial lines and wrinkles.
Both soft tissue fillers and Botox injections are regarded as effective though temporary alternatives to a forehead lift for reducing frown lines. Collagen injections must be repeated every three to six months, while Botox injections are effective for about four months.
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Rebecca Frey, Ph.D.
WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?
A forehead lift is a specialized procedure performed only by a qualified plastic surgeon. Plastic surgeons are doctors who have completed three years of general surgical training followed by two to three years of specialized training in plastic surgery after completing their MD or DO degree.
QUESTIONS TO ASK THE DOCTOR
- How many forehead lifts have you performed?
- Should I consider combining the forehead lift with a face lift?
- Am I a candidate for an endoscopic forehead lift?
- Would I benefit from nonsurgical alternatives to a forehead lift?
- How long can I expect the effects of this surgery to last?
Table Of Contents
- Classic forehead lift
- Endoscopic forehead lift
- Normal results
- Morbidity and mortality rates
- Soft tissue fillers
- Botulinum toxin
- WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?
- QUESTIONS TO ASK THE DOCTOR