Forehead lift
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A forehead lift, also known as a browlift or browplasty, is a cosmetic surgery procedure used to elevate a drooping eyebrow that may obstruct vision and/or to remove the deep “worry” lines that run across the forehead and may portray to others anger, sternness, hostility, fatigue or other unintended emotions.[citation needed]
Overview of the procedure
A forehead lift, also sometimes referred to as a browlift is a surgical procedure to change the position of the soft tissues of the forehead and thereby the appearance of the upper face and also reduce sagging of skin in the eyebrows and above the nose.
Multiple surgical approaches have been developed, and more than one may be used in combination by surgeons wishing to elevate the forehead skin.
A direct browlift is performed by removing an segment of skin and muscle just above the eyebrows. The incision is hidden within the brow hair. This technique does not address wrinkles or lines within the forehead and surgical scars may be prominent. It is typically reserved for older patients or for men with thick eyebrow hair and male pattern baldness for whom other techniques might result in unacceptable elevation of the hairline.
A mid-forehead lift is intended for patients who have heavy sagging eyebrows and the deeper forehead wrinkles. The surgeon makes incisions within the deep forehead wrinkles and removes the excess skin, fat and sometimes muscle. Incisions are made within the deep wrinkles so that the resulting scars are concealed within the skin lines and not very noticeable after healing. The advantage of this technique is that less of the forehead tissues need to be loosened at surgery to elevate the eyebrows and less skin needs to be removed when a site is chosen within the lines in the lower part of the forehead. Because this technique does not require elevating the skin of the whole forehead, the position of the hairline is not affected. This is advantageous for patients with high hairlines for whom more elevation of the hairline would be undesirable.
A coronal forehead lift is performed by making an ear to ear incision across the top of the head and elevating the entire forehead and brow. The advantage of this technique is that incisions are not made on the face. The disadvantages are that a large area of skin and underlying tissues in the forehead must be loosened in order to elevate the brows and the loosened tissues are then stretched toward the top of the head, raising the position of the hairline. Depending on where the hairline is located before surgery, the elevated hairline may or may not produce a desirable appearance. Excess skin is usually removed from the incision area, which may result in loss of hair-bearing scalp skin. Because of the length of the incision--from one side of the head to the other across the top of the head--a longer scar necessarily results, which if within the hair-bearing part of the scalp may not be noticeable, but in persons with thinning hair, might leave a visible scar. For the surgeon, the longer incision also presents issues of bleeding control which may require special instruments and a longer operating time. One version of this procedure, sometimes called a pre-trichal lift, requires an incision in the skin in the upper forehead just in front of the hairline. The sides of the incision may be made either in front of the hairline at the temples or behind the hairline. In this approach, loose forehead skin is stretched upward and removed just in front of the hairline, leaving the hairline height unchanged but allowing removal of excess forehead skin. The advantage is not changing the position of the hairline. The disadvantages are otherwise those of the coronal browlift.
Another technique, called an endoscopic forehead lift, involves the use of instruments along with a surgical endoscope placed under the forehead skin through small incisions. The procedure loosens the forehead skin and elevates the brows and smooths forehead wrinkles by stretching the loosened forehead tissues upward toward the top of the head. Suspending sutures are sometimes used between the underside of the stretched skin and the forehead bones to support the elevated skin and brows. The advantage of this surgical technique is smaller incisions, less bleeding, and faster healing. Often the skin of the scalp must also be loosened from the underside to allow the elevated and stretched skin to lay flat against the skull bones. The disadvantage of this technique is that it may result in elevating the patient's hairline higher than is cosmetically desired.
History
The first documented medical discussion about a forehead lift was written in 1910 by the famous German surgeon Erich Lexer.[1]
The main surgical method of lifting the forehead from Lexer’s time up until the 1950s was then known as a coronal, or open, forehead lift.
While the procedure is currently used far less frequently, the surgeon began the procedure by making one, long incision running from ear to ear over the top of the head through the hairline. The surgeon lifted the skin and muscles upwards and free from the bone, pulled the tissues up toward the top of the head, trimmed the excess and closed the incision with sutures. The incision was initially made well into the hairline so the scar could not later be seen.
In some cases, especially those in which the eyebrows and forehead skin are not too heavy, the upper eyelids are also elevated. In most cases, the procedure provides the smoother appearance which many patients want to help look younger and more refreshed and rested[2] In the late 1950s, and 60s some surgeons achieved the younger appearance on the forehead by scoring or removing some of the small forehead muscles -- most notably the frontalis muscle which causes frowning and grimacing.
Current surgical techniques
Since the advent of the hugely popular wrinkle remover, Botox (Dysport in the United Kingdom and Europe) many consumers have eschewed the invasive surgery altogether, opting for Botox injections every four to six months to get the same results. Botox is also used after some forehead lift procedures to increase the effects of the surgeries.[3]
Endoscopic surgery is often employed in forehead lifts. An endoscope is a surgical system with thin, pencil-sized arms that are inserted through three to five incisions about 3/8 of an inch long. One of the instrument’s arms is a lighted camera that displays what it sees under the patient’s skin on a television monitor.[4]Other arms on the Endoscope carry actual surgical tools that perform cutting, or grasping functions. The surgeon watches the television monitor to guide his movements.
Yet another advancement to endoscopic forehead lift surgery is with a fixation device known as an Endotine[5] The bioabsorbable Endotine implant is:
- Essentially a hanger with five small tines
- Affixed by inserting a flanged post into a drill hole in the skull
First, the surgeon frees the tissues of the forehead from the skull, then lifts them upwards and engages them onto the implant tines which hold them in place. The upside is the surgeon can readjust the height of the lift by simply moving the tissues up on the Endotine. If left undisturbed for 30 to 60 days, the forehead tissues heal to the bone at the higher position. The body absorbs the Endotine in about four to seven months. However, patients report they can feel the Endotines under the skin for some months after their procedures.
Forehead lifts can also be combined with hairline lowering for patients that wish to have their hairline lowered at the same time as the forehead is raised.
Risks
When surgeons have problems with an endoscopic forehead lift, -- in about one percent of cases -- they finish the procedure by switching to the open forehead lift method.
Complications are said to be rare and minor when a forehead lift is performed by a surgeon trained in the technique. However, it is possible for the surgical process to damage the nerves that control eyebrow and forehead movements. Hair loss can also occur along the scar edges in the scalp when an incision is made through the hairline. Moreover, infection and bleeding are possible with any surgical procedure.[6]
Patients who have Endotine implants in their foreheads risk moving their newly adjusted tissues with relatively small movements just after the operation and before complete healing takes place. While the implant absorbs into the body, the Endotine generally does not support the very thick forehead flesh and heavy brows often seen in some overweight males.[7]
References
- ^ Ulrich T. Hinderer and Juan L. Del Rio: Erich Lexer’s Mammaplasty: Aesthetic Plas Surg; Vol 16, No2; March 1992; 1001-1007
- ^ Paul, Malcolm D: Subperiosteal transblepharoplasty forehead lift: Aesth Plas Surg:Vol 20, No 2; March, 1996: 129-134;
- ^ Dyer WK Jr., Yung RT: Botulinum toxin-assisted brow lift. Facial Plast Surg 2000 Aug; 8(3): 343-54
- ^ Romo T 3rd, Sclafani AP, Yung RT: Endoscopic foreheadplasty: a histological comparison of perosteal refixation after endoscopic versus bicorronal lift. Plast Reconstr Surg 2000 Mar; 1111-7; discussion 1118-9
- ^ 8 “Keyhole” Plastic & Cosmetic Surgeries
- ^ Morgan JM, Gentile RD, Farrior E: Rejuvenation of the forehead and eyelids complex. Facial Plast Surg 2005 Nov; 21(4):271-8
- ^ Ramirez OM: Why I prefer the endoscope forehead lift. Plast Reconstr Surg 1997 Sep; 100(4): 1033-9; discussion 1043-6