A forehead lift or “browlift” is a procedure that restores a more youthful, refreshed look to the area above and around the eyes. The procedure corrects drooping brows and improves the horizontal lines and furrows that can make a person appear angry, sad or worried. It can also correct excess, hanging upper eyelid skin that makes one look tired.
In a forehead lift, the muscles that cause the furrowing or drooping of the brow are removed to smooth the forehead, raise the eyebrows and minimize frown lines. Dr. Zemmel typically performs a browlift by using the newer minimally invasive Endoscopic technique. Dr. Zemmel therefore avoids the conventional surgical method, which utilizes an incision extending from ear to ear behind the hairline. The newer methods involve 3 small ½ inch incisions hidden well beneath the hairline. By using a small fiber optic camera to do the surgery the larger incisions are not necessary. This speeds your recovery and allows you to return to normal activities faster. Both techniques give excellent results with patients feeling more refreshed and rejuvenated a couple of weeks after surgery.
If you’re considering a forehead lift, this page will provide a basic understanding of the procedure. Dr. Zemmel will provide more detailed information and answer all of your questions at the time of your initial consult.
Candidates For A Browlift
A forehead lift is most commonly performed in 35 to 60 years olds 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.
Brow lifting is often performed in conjunction with eyelid surgery (blepharoplasty) to provide an overall balance revitalized look to the entire area around the eyes. Patients who believe they need upper-eyelid surgery often find that a forehead lift better meets their surgical goals. Some patients also benefit from a full facelift with a brow lift to complete overall facial rejuvenation.
Patients who are bald, who have a receding hairline, or who have had previous upper-eyelid surgery may still be good candidates for a brow lift. If necessary, Dr. Zemmel will alter the location of the incisions if possible to hide them in inconspicuous places.
Remember, a brow lift can enhance your appearance and your self-confidence. It can give you a more refreshed look. Dr. Zemmel strives to provide his patients will natural brow lift results. Instead of a looking “surprised,” you will look as if you had a great night’s sleep.
Before you decide to have surgery, think carefully about your expectations and discuss them in detail with Dr. Zemmel.
Complications are rare and usually minor with brow lifting. 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 to correct the problem.
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 brow lift, Dr. Zemmel 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. Zemmel’s instructions both before and after surgery.
Planning Your Surgery
For a basic understanding of how a browlift 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.
During your initial consultation, Dr. Zemmel will evaluate each detail of your upper face in order to plan the operation:
- The quality of your skin
- The position of your eyebrows
- The position of your hairline
- The amount of excess skin of your upper eyelids
- Asymmetry between your eyes and eye brows
- The bone structure of your forehead and eyes
- The muscle tone of your forehead
- The wrinkles across your forehead, frown lines, and crow’s feet
During your consultation, Dr. Zemmel will discuss your goals for the surgery and ask you about certain medical conditions that could cause problems during or after the procedure, such as uncontrolled high blood pressure, blood-clotting problems, or the tendency to develop large scars. Be sure to tell Dr. Zemmel if you have had previous facial surgery, if you smoke, or if you take any drugs or medications — including aspirin or other drugs that affect clotting.
If you decide to proceed with a brow lift, Dr. Zemmel will explain the surgical technique. He recommends deep sedation with local anesthesia for the procedure. Dr. Zemmel performs the procedure in the office on an outpatient basis.
Preparing For Your Surgery
Dr. Zemmel will give you specific instructions to prepare for the procedure, including guidelines on eating and drinking, smoking, and taking and avoiding certain vitamins and medications. Carefully following these instructions will help your surgery and your recovery proceed more smoothly. You will also be provided with a detailed patient instruction sheet for before and after surgery.
Where Your Surgery Will Be Performed
Dr. Zemmel’s operating room is a critical component of the quality of his care. The facility has the full accreditation by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). Brow lifting is done on an outpatient basis.
Anesthesia Used For The Procedure
Brow lifts are performed under local anesthesia, combined with a sedative to make you drowsy. You’ll be sleeping and relaxed and mostly unaware of the procedure. You will not feel any pain during the operation.
Dr. Zemmel will help you decide which surgical approach will best achieve your cosmetic goals: the classic or “open” method, or the Endoscopic forehead lift. Make sure you understand the technique that Dr. Zemmel recommends and why he feels it is best for you.
The Traditional 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, but hair that is growing directly in front of the incision line may need to be trimmed.
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.
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, Dr. Zemmel may recommend an Endoscopic approach.
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. Your face and hair will be washed to prevent irritation and the rubber bands will be removed from your hair.
The Endoscopic Browlift
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. Zemmel will make three short scalp incisions, each less ½ an inch in length. The endoscope, which is a pencil-like camera device connected to a television monitor, is inserted through one of the incisions, allowing Dr. Zemmel 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 will also be lifted and secured into their higher position by sutures beneath the skin’s surface.
When the lift is complete, the scalp incisions will be closed with stitches and the area will be washed.
After Your Surgery
Classic forehead lift patients may experience some numbness and temporary discomfort around the incision, which can be controlled with prescription medication. Patients who are prone to headaches may be treated with an additional longer-acting local anesthesia during surgery as a preventive measure.
You will be told to keep your head elevated for three days following surgery to keep the swelling down. Swelling may also affect the cheeks and eyes– however, this should begin to disappear in a week or so.
As the nerves heal, numbness on the top of your scalp may be replaced by itching. These sensations may take as long as six months to fully disappear. Dr Zemmel will remove the stitches 10 days after surgery
Some of your hair around the incision may fall out and may temporarily be a bit thinner. Normal growth will usually resume within a few weeks or months. Permanent hair loss is rare.
Endoscopic forehead lift patients may experience some numbness, incision discomfort and mild swelling.
Incision site pain is usually minimal, but can be controlled with medication, if necessary. Endoscopic forehead lift patients usually experience less of the itching sensation felt by patients who have had the classic forehead lift.
The stitches used to close the incisions are usually removed in 10 days.
Getting Back To Normal
Although you should be up and about in a day or two, plan on taking it easy for at the first week after surgery. You should be able to shower and shampoo your hair within two days.
Most patients are back to work in a week. Endoscopic patients may feel ready to return even sooner. Vigorous physical activity should limited for several weeks, including jogging, bending, heavy housework, sex, or any activity that increases your blood pressure. Prolonged exposure to heat or sun should be limited for several months.
Most of the visible signs of surgery should fade completely within about three weeks. Minor swelling and bruising can be present but it usually not noticeable. You may feel a bit tired, but your energy level will increase as you begin to look and feel better.
Your New Look
The great majority of patients are pleased with the results of a forehead lift. 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. Dr. Zemmel will take extensive before and after pictures to show you your new look.