Forehead Lift
Procedure: Forehead Lift
Surgery Length: 2 hours
Anesthesia: Local with heavy sedation
Where: Outpatient Hospital
Recovery: Temporary swelling and bruising (resolving in approximately one week), possible temporary paralysis of forehead area, Temporary numbness of scalp and forehead area.
Back to work: 4-9 days
Full activities: 1-2 days
Risks: Bleeding, infection, Scaring (depending on approach, usually hidden in hair), unresolved numbness to scalp or forehead area (Rare), unresolved paralysis forehead area (Extremely rare)
Classically this operation was done, (and is still done by may plastic surgeons) by using, an incision from the temporal to frontal to temporal scalp so as to allow resection of portions of spastic forehead and nasal bridge muscles causing excessive wrinkling, as well as the uplift of the forehead skin to relieve heavy eyebrow positioning. The procedure can also be done through much more limited incisions with an Endoscope (closed technique) and achieve similar results as with the open (ear-to-ear incision) technique.
In the case of furrowing or wrinkling of the forehead, a forehead or coronal lift is often recommended. This is particularly so in patients with a narrow forehead and a pleated brow appearance. The vertical wrinkles above the nose can likewise be addressed in a forehead lift.
In the cases where the eyebrows are hooded or quite low over the eyes, a more youthful appearance to the eyes can be achieved by lifting up the forehead alone. In some cases a simultaneous or staged blepharoplasty (upper eyelid operation) is required to compliment this improvement. In cases where visual compromised is due to hooding of the eyelids, your insurance carrier should cover most of the surgical fees for the blepharoplasty (rarely will they cover the cost of the forehead lift). We will send to your carrier, photos, a letter of explanation, and a report of visual field disturbance from your ophthalmologist or optometrist. This is usually done prior to your operation, but in the case of Medicare, they will only evaluate cases after the operation with no guarantee of coverage. Such cases will have to pay for Hospital and anesthesia, and surgical services prior to surgery and seek reimbursement later from Medicare.
In terms of the pleats of the forehead area and the vertical wrinkles around the bridge of the nose, one would definitely gain improvement with a forehead lift, but would not totally eradicate these horizontal pleats or folds. The wrinkles at the corrugator area (bridge of the nose) would be benefited in that the muscles which cause this deformity are resected at the time of the operation. (In addition, a portion of the forehead muscle or frontalis muscle is removed to further facilitate thinning out of the forehead.) A major problem from the forehead lift is the possibility of a wide scar on the upper scalp area. However, this can be easily covered with your hair style. The exception to this is in males who have receding frontal hairlines or insist upon keeping a prominent hair part. For them, these scalp scars may be quite noticeable. There is also some complaint of numbness of the scalp area secondary to nerves which are divided in the process of uplifting the flap. These nerves make for not only numbness of the posterior scalp, but also could make for numbness of the forehead area. In addition, there is a possibility of injury to the nerves which innervate the muscles of the forehead giving you a paralysis of the forehead area. This is usually quite temporary but can occur even on a permanent basis in very rare instances, and therefore, is mentioned as a possible side effect of the operative procedure. An alternative of the forehead lift is the endoscopic forehead lift done with four small internal incisions behind the frontal hairline. These incisions allow placement of a tube attached to a T.V. monitor. Using a special instrument, similar techniques done in the open technique are used, including the pulling and upward advancement of the forehead skin. This procedure is advantageous over the open technique as the scalp scars are less prominent. Note that in cases of exaggerated asymmetry of the brow, or heavy brow ptosis, the open technique is optimal for better correction. However, lately even these type of cases do well with advanced techniques done endoscopically.
As in any operative procedure, bleeding and infection at the incision sites are potential problems. For that reason we ask our patients to refrain from using Vitamin E and aspirin products for two weeks prior to surgery. These products tend to increase the chance of bleeding. We also insist that patients refrain from smoking or chewing Nicorette gum two weeks before and one week after surgery. Nicotine compromises blood supply to the skin. Occasionally loss of skin and hair are seen with this operation and particularly so in those patients who smoke.
Whether done with eyelid surgery or in conjunction with a full facelift, the forehead lift operation can be performed under local anesthesia and heavy sedation or general anesthesia in the outpatient surgical unit. A nurse anesthetist or anesthesiologist is in attendance. After the operation the patient is released to the care of a loved one at home and is usually seen the following day. A drain is usually removed at that time.
If a lot of bruising occurs, the down time for a patient with an endoscopic lift is approximately one to two weeks for resolution of all black and blue around your eyes. Most resolve quite quickly and measure their recovery in days. The sutures are removed in seven to fourteen days after surgery. The swelling and most black and blue is usually fairly well resolved after the first week. In contrast, when the open coronal lift is done, then the down time will be identical to that for the facelift. Details regarding the facelift are included in another brochure and will be given to you upon request.
Please feel free to ask Dr. Kennedy or any member of the staff questions on any of these points raised.
