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If you're considering a forehead lift...
A forehead lift or "browlift" is a procedure that restores a more youthful, refreshed look to the area above the eyes. The procedure corrects drooping brows and improves the horizontal lines and furrows that can make a person appear angry, sad or tired.
In a forehead lift, the muscles and tissues that cause the furrowing or drooping are removed or altered to smooth the forehead, raise the eyebrows and minimize frown lines. Dr Lista uses two techniques for performing a brow lift. In the conventional surgical method the incision is hidden just behind the hairline; or it may be performed with the use of an endoscope, a viewing instrument that allows the procedure to be performed with minimal incisions. Both techniques yield similar results -- smoother forehead skin and a more animated appearance.
If you're considering a forehead lift, this web page will provide a basic understanding of the procedure -- when it can help, how it's performed and what results you can expect. It won't answer all of your questions, since a lot depends on your individual circumstances. Dr Lista wants all of his patients to be as well informed as possible and encourages them to bring a list of questions to their consultation.
At the Plastic Surgery Clinic we perform approximately 40 to 50 brow lift procedures per year. This makes Dr Lista a very experienced brow lift surgeon. Dr Lista has one main philosophy when performing brow lifts: to make all his brow lift patients look soft and natural, and perform the operation as safely as possible. We want the patient to look rested and relaxed, the way they looked 10 years ago. Dr Lista strives to avoid making his patients look tight or pulled. Today, a number of new techniques are helping plastic surgeons to provide patients with more precise results and quicker recovery times.
The best candidates for a forehead lift. . .
A forehead lift is most commonly performed in the 40-60 age range to minimize the visible effects of aging. However, it can also help people of any age who have developed furrows or frown lines due to stress or muscle activity. Individuals with inherited conditions, such as a low, heavy brow or furrowed lines above the nose can achieve a more alert and refreshed look with this procedure.
Forehead lift is often performed in conjunction with a facelift to provide a smoother overall look to the face. Eyelid surgery (blepharoplasty) may also be performed at the same time as a forehead lift, especially if a patient has significant skin overhang in the upper eyelids. Sometimes, patients who believe they need upper-eyelid surgery find that a forehead lift better meets their surgical goals.
Patients who are bald, who have a receding hairline, or who have had previous upper-eyelid surgery may still be good candidates for forehead lift. The surgeon will simply alter the incision location or perform a more conservative operation.
For a better understanding of how a forehead lift might change your appearance, look into a mirror and place the palms of your hands at the outer edges of your eyes, above your eyebrows. Gently draw the skin up to raise the brow and the forehead area. That is approximately what a forehead lift would do for you.
Remember, a forehead lift can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and we encourage you to discuss them in detail with Dr Lista.
The Office Visit
Dr Lista sees all his patients personally before surgery. If the patient lives in the Toronto area he prefers to see his patients twice, if possible, before their operation. In the consultation process we spend considerable time obtaining a careful history and physical examination. Facelifts are very individualized procedures. In your initial consultation Dr Lista will evaluate your face, including the skin and underlying bone, and discuss your goals for the surgery. We also spend a long time discussing the patient’s desires, goals and expectations. It is important that the patient discuss with Dr Lista their desired result. Not all expectations can be accomplished with surgery and it is important that these issues are carefully discussed before surgery. Photographs can be helpful in this regard and at The Plastic Surgery Clinic we have computerized digital imaging, which allows Dr Lista to show the patients examples of how they may look after surgery.
How Forehead lift is performed
Most forehead lift procedures are performed at The Plastic Surgery Clinic. Dr Lista performs all of the procedures personally. He does not have any assistants or students assist with your surgery. Dr Lista is Chief of Plastic Surgery at the Trillium Health Center (The Mississauga Hospital) so your operation can also be performed at the hospital if you prefer. The operation is performed either at our clinic or in the hospital. Your operation may be performed under local anesthesia with sedation or under general anesthesia. At the Plastic Surgery Clinic general anesthetics are administered by specialist physicians who are board certified in the specialty of anesthesia. These doctors give the anesthetic, stay with the patient during the entire operation and are with the patient while they are waking up. The operation takes about two hours. A friend or relative will need to come and pick you up and stay with you for 24 hours.
Preparing for your surgery
Dr Lista will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly. If you smoke, it's especially important to stop at least two weeks before and after surgery; smoking inhibits blood flow to the skin, and can interfere with the healing of your incision areas.
Dr Lista will help you decide which surgical approach will best achieve your cosmetic goals: the classic or "open" method, or the endoscopic forehead lift.
The classic forehead lift: Before the operation begins, your hair will be tied with rubber bands on either side of the incision line. Your head will not be shaved and no hair will be cut.
For most patients, a coronal incision will be used. It follows a headphone-like pattern, starting at about ear level and running across the top of the forehead and down the other side of the head. The incision is usually made well behind the hairline so that the scar won't be visible.
If your hairline is high or receding, the incision may be placed just at the hairline, to avoid adding even more height to the forehead. In patients who are bald or losing hair, a mid-scalp incision that follows the natural pattern of the skull bones is sometimes recommended. By wearing your hair down on your forehead, most such scars become relatively inconspicuous. Special planning is sometimes necessary for concealing the scar in male patients, whose hairstyles often don't lend themselves as well to incision coverage.
If you are bald or have thinning hair, Dr Lista may recommend a mid-scalp incision so the resulting scar follows the natural junction of two bones in your skull and is less conspicuous.
Working through the incision, the skin of the forehead is carefully lifted so that the underlying tissue can be removed and the muscles of the forehead can be altered or released. The eyebrows may also be elevated and excess skin at the incision point will be trimmed away to help create a smoother, more youthful appearance. The incision is then closed with stitches and clips. Your face and hair will be washed to prevent irritation and the rubber bands will be removed from your hair.
The endoscopic forehead lift: Typically, an endoscopic forehead lift requires the same preparation steps as the traditional procedure: the hair is tied back and trimmed behind the hairline where the incisions will be made.
However, rather than making one long coronal incision, Dr Lista will make four or five short scalp incisions, each less than an inch in length. An endoscope, which is a pencil-like camera device connected to a television monitor, is inserted through one of the incisions, allowing Dr Lista to have a clear view of the muscles and tissues beneath the skin. Using another instrument inserted through a different incision, the forehead skin is lifted and the muscles and underlying tissues are removed or altered to produce a smoother appearance. The eyebrows may also be lifted and secured into their higher position by sutures beneath the skin's surface or by fixation screws placed behind the hairline. When the lift is complete, the scalp incisions will be closed with stitches and clips and the area will be washed.
Following surgery, a small, thin tube may be temporarily placed under the skin behind your ear to drain any blood that might collect there. Dr Lista will wrap your head loosely in bandages to minimize bruising and swelling. There isn't usually significant discomfort after surgery but if there is, it can be lessened with the pain medication prescribed by Dr Lista. The next day the tubes will be removed and the large dressing will be replaced with a much lighter dressing. You will be able to begin showering and washing your hair the next day.
Getting back to normal
You should be up and about in a day or two, but plan on taking it easy for the first week after surgery. Be especially gentle with your face and hair, since your skin will be both tender and numb, and may not respond normally at first.
Dr Lista will give more specific guidelines for gradually resuming your normal activities. They're likely to include these suggestions: Avoid strenuous activity, including sex and heavy work, for at least two weeks (walking and mild stretching are fine). Above all, get plenty of rest and allow your body to spend its energy on healing. You can start gentle exercise in two weeks but strenuous aerobics or weight lifting should be avoided for a month.
You will need to take one week off work. Most patients are back at work in about ten days to two weeks after surgery. Endoscopic patients may feel ready to return even sooner. If you need it, makeup can mask most bruising that remains.
All surgery carries some uncertainty and risk
Complications are rare and usually minor when a forehead lift is performed by a qualified plastic surgeon. Yet, the possibility of complications must be considered.
In rare cases, the nerves that control eyebrow movement may be injured on one or both sides, resulting in a loss of ability to raise the eyebrows or wrinkle the forehead. Additional surgery may be required but the problem may be permanent. Formation of a broad scar is also a rare complication. This may be treated surgically by removing the wide scar tissue so a new, thinner scar may result. Also, in some patients, hair loss may occur along the scar edges. Loss of sensation along or just beyond the incision line is common, especially with the classic forehead lift procedure. It is usually temporary, but may be permanent in some patients. Infection and bleeding are very rare, but are possibilities.
If a complication should occur during an endoscopic forehead lift, Dr Lista may have to abandon the endoscopic approach and switch to the conventional, open procedure, which will result in a more extensive scar and a longer recovery period. To date, such complications are rare -- estimated at less than 1 percent of all endoscopy procedures.
You can reduce your risk of complications by closely following Dr Lista’s instructions both before and after surgery.
Your new look
Most patients are pleased with the results of a forehead lift, no matter which surgical method was used. Often, patients don't realize how much their sagging forehead contributed to the signs of aging until they see how much younger and more rested they appear after the lift.
Although a forehead lift does not stop the clock, it can minimize the appearance of aging for years. Your face will continue to age with time, and you may want to repeat the procedure one or more times-perhaps five or ten years down the line. But in another sense, the effects of even one forehead lift are lasting; years later, you'll continue to look better than if you'd never had a forehead lift at all.