The operation is usually performed under general anaesthetic and depending on the technique either as an out- or a short inpatient procedure.
The aim of the forehead lift is to elevate the eyebrows and smoothen the forehead wrinkles. This can either be done with an “open” technique or minimally invasive, “endoscopic” technique.
This technique is suitable for cases where there are wrinkles and eyebrow ptosis, but no excess skin which needs to be removed. Three small incisions are made within the hair bearing scalp through which a camera and dissecting instruments can be inserted. Under direct vision a tunnel is created underneath the skin and forehead muscles down to the eyebrows which are then freed from any deep attachments. By pulling on the forehead muscles at the incision sites, the eyebrows can be raised to the desired position. The muscle is fixed with bone anchors in the new position.
Deep wrinkles and significant skin excess can only be corrected sufficiently by removing skin.
If the wrinkles are mostly in the lower part of the forehead and are very deep, such as they typically are in males, merely removing a strip of excess skin from above the eyebrows can successfully correct the eyebrow position. The resulting scar can be placed so that it falls into an existing skin crease and is barely visible.
In most cases though it is desirable to place the scars outside the face. In a traditional open brow lift the incision is placed right along and just at the edge of the hair bearing scalp. This allows the entire forehead to be smoothened, the eyebrow position to be optimized and the skin excess to be removed.
Both techniques allow the option of cutting and partially removing the muscles in between the eyebrows that are responsible for frown lines. This is particularly desirable for patients who regularly have that area treated with botulinum toxin.
The skin incisions are usually closed with fine non-absorbing sutures or staples within the scalp, which are removed after approximately 7-10 days.
What to expect after the operation
The skin around the eye is very thin and prone to swelling and discoloration. As hematomas and swelling follow gravity, it is therefore very common for the entire eyelid, sometimes also the lower eyelids, to swell up and turn blue, even if they weren’t touched during surgery. This can be reduced by cooling the area immediately after surgery for 24-48 h and keeping the head slightly elevated.
The final result can usually be appreciated after about 6-8 weeks, once all the postoperative swelling has gone down. During this time the entire forehead region will feel quite tight and the position of the eyebrows may seem too high.
Especially during an open brow lift, the nerves that are responsible for sensation of the skin the front part of the scalp are severed when the skin incision is placed. The resulting numbness can last for many months and in some cases never recovers entirely. This cannot be prevented surgically.
Keep the head slightly elevated (at least 30 deg) and cool the eyelids (not with ice as it can cause thermal damage) for at least 48 h after surgery
The sutures will be removed approximately 10 days after surgery and the dressings can be left intact until then.
Showering and washing your hair is usually allowed after 48h, however rubbing the eyelids should be avoided until the wounds have healed completely.
Makeup can be applied anywhere more than 1cm away from the wounds after 48h.
Everyday activities are usually possible immediately after surgery, however strenuous activities, including exercise should be avoided until the swelling has gone down.
Regular follow-up appointments with your surgeon will be scheduled at 1 week, 6 weeks, 3 months and 1 year after surgery.
As with every surgical procedure brow/forehead lift is associated with both anaesthetic and surgical risks. Preexisting conditions such as Diabetes, obesity, heart and blood vessel diseases, immune diseases and smoking significantly increase the risk of complications.
The most common surgical complications after brow/forehead lift include:
- postoperative bleeding, hematoma
- under- or overcorrection
- unsightly or asymmetrical scars
- persistent swelling
- alopecia (disturbed hair growth)
- numbness of the forehead skin and scalp
Rare complications after upper eyelid blepharoplasty include:
- delayed wound healing, wound breakdown or skin slough
- injury to the facial nerve
Do I need to stop my own medication prior to surgery?
Most medication can be continued normally. Some drugs such as blood thinners (e.g. Aspirin or Warfarin/Marcoumar) can increase the risk of postoperative bleeding and may need to be stopped or replaced before the procedure. We ask you to bring a complete list of all your medication and their dosages to your first consultation.
Does my GP need to perform or organize any special investigations or tests before surgery?
Usually not. We ask you to provide as much detailed information on your past medical history as possible when you come for your preoperative consultation so we can coordinate any necessary tests with your GP.
Do I need to stop smoking before surgery?
We seriously recommend stopping all nicotine consumption, including smoking at least 6 weeks before any surgical procedure. One of the most common complications following any type of surgery is delayed wound healing or wound breakdown. The main cause of this is usually bad blood circulation to the skin and tissues in the operated area. Nicotine is a chemical substance, which causes blood vessels in the body to constrict (narrow). This lowers the blood circulation to the wound and significantly increases the risk of complications.
How long before I can go back to work after surgery?
This depends on your work. Light duties, such as office jobs can usually be resumed immediately after surgery. However, your eyelids will be quite swollen and discoloured for at least a week after the procedure, so it is advisable not to schedule your surgery immediately before any public events.
Which is the ideal age to have a brow/forehead lift?
There is no real “ideal age” for any aesthetic procedure, especially as each individual ages differently and has a different perception of their appearance. Most importantly the expectations of what changes can be achieved must be realistic and the potential physical and psychological benefits of any aesthetic procedure must outweigh both the surgical and anaesthetic risks.
How long does a brow/forehead lift last?
This is highly individual. No aesthetic procedure can stop the ageing process, as both the changes of the tissues themselves and the effects of gravity remain ongoing. On average a brow/forehead lift will last between 5 – 10 years.
I already had a brow/forehead lift in the past. Can the procedure be done again?
Yes. Lifting procedures can be repeated, however the risk of complications are higher as the anatomy becomes distorted through scarring and the quality of the skin and soft tissue suffer with each re-do procedure. Also the expectations of the aesthetic outcome cannot be the same as for the first operation.
My eyebrows are not at the same height. Can this be corrected?
No-one has a completely symmetrical face and although the position of each eyebrow position can be corrected to match the other it is often technically not possible to achieve 100% symmetry.
I would like more than one area of my face lifted. Can this be done in the same operation?
Yes, it is technically possible to perform an entire face and neck lift in the same operation and in some cases even recommended to achieve the best overall result. It does however significantly extend both the operation time (up to 7 hours) and the recovery time.
What happens if the facial nerve is injured during surgery?
The facial nerve, which originates from just below the earlobe, has five main branches that are responsible for controlling movement of the muscles in different areas of the face. If one of these main branches is severed, the corresponding muscle group will be paralyzed. The nerve branch at risk during a brow lift controls the forehead muscle and the muscle that closes the eyelid (orbicularis oculi muscle). If the nerve is cut the eyebrow will hang low and you may not be able to close your eye completely. It is quite common for nerves to react to tissue swelling in the first days after surgery with temporary loss of function. If however the paralysis remains beyond 1-2 weeks, the surgical site must be explored and the nerve repaired. The amount of function that can be regained after nerve repair depends on age, localization of the injury and a number of other individual factors.
Can I wear make-up after the operation?
Once the wounds have healed completely (approximately 1 week after surgery) you can apply make-up freely. Before this time the wound itself should be kept clean and dry. You may apply make-up to the surrounding areas though.
Will I get a sick certificate for the time I am off work?
No. Sick certificates cannot be issued for cosmetic procedures. You will need to take leave for the entire period that you are absent from work.
Will my health insurance cover the costs for the surgery?
No. A brow/forehead lift is a purely aesthetic procedure which is not covered by health insurance.
Will my health insurance cover the costs of treatment if I develop any complications requiring medical treatment, hospitalization or even further surgery?
Yes, provided the complication is purely medical, e.g. an infection. Corrections of aesthetic complications (e.g. asymmetry, scarring, under- or overcorrection etc.) are not covered.