Forehead lift



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Eyelid correction or forehead lift

Nowadays we make a distinction between fatigue and a tired appearance caused by drooping eyebrows or by hooded eyes. An eyelid correction for drooping eyebrows only provides a slight and temporary improvement. A lift of the forehead will offer a more permanent solution.

There are different techniques for an eyebrow lift and a forehead lift. I will assess the best technique for you on an individual basis.

Photo album Foreheadlift

1. Subcutaneous forehead lift or endoscopic lift

The endoscopic forehead lift has gained a solid position in the treatment of drooping eyebrows.

However, this technique has its limitations in patients with:
a) A high forehead.
b) Extremely low placed eyebrows, or substantial agility of the skin around the eyebrows usually at a senior age.

In these cases a subcutaneous forehead lift (via an incision in the hairline) will give a better result. In some cases, a limited eyebrow lift with a small scar in the edge of the eyebrow is sufficient (see chapter 2).

With the subcutaneous lift the skin of the forehead and the eyebrows are repositioned relative to the underlying muscles. Skin is removed so that the height of the forehead remains unchanged or is slightly shorter. The latter is often aesthetically preferable. The scar is positioned within the hairline.

With the endoscopic lift the eyebrows, the forehead skin and the muscle in the forehead will be detached from the bone and will be moved upwards. This slightly raises the hairline, so that the forehead will be higher. The scars will be hidden in the hair.

Both methods have their advantages and disadvantages so these will be carefully weighed on an individual basis in order to get the best result.

2. Small or direct eyebrow lift

Eyebrow lift

In the small or direct eyebrow lift, the skin is removed with an incision in the upper edge of the eyebrow and the outside of the eyebrow is lifted.

All techniques have their own advantages and disadvantages and a well-considered choice is important for a good result.

On the left an example of an eyebrow lift before and shortly after surgery.

3. For whom is a forehead lift a relief?

For those who after a working day feel their eyelids close as if they are heavy. Or for those who have a worrisome or angry facial expression even if they are in a good mood. Frequently it happens that people ask them if they are upset or angry. Some suffer from headaches related to tension. One can imagine that constant frowning strains the muscles and causes these to ache. The pain can extend to the neck. The muscle in the forehead will be less burdened after the lift and the headache will vanish. The lift will also have a positive effect on the grooves in the forehead, the frown wrinkles above the nose and the position of the eyebrows. You will look younger, friendlier, more relaxed and rested.

I also apply the endoscopic method in order to remove a lipoma or exostosis from the forehead without leaving a scar.

4. Cause?

Lower eyebrows are mainly congenital. Because of aging this will result in abovementioned complaints at age 40 to 50, in extreme cases even at a younger age. The process is gradual and one gets used to the lowering eyebrows. Diagnosis and treatment will therefore be literally and figuratively an eye-opener.

A drooping eyelid as such doesn’t have to give a sad, worrisome or angry expression; a low position of the eyebrows does. Just think about it, when you look angry, you frown and your eyebrows are pulled down.

Forehead lift

5. Is there a difference between men and women?

Scar in hairline

Usually the eyebrows of a woman are positioned higher than those of men.

With balding men, where there is no hairline on the forehead, the scar is positioned in one of the forehead wrinkles. The other option is to opt for the small lift with the scar in the eyebrow.

On the photos below you can see the scar, which in this case - with a receding hairline at the man - is positioned in a wrinkle over the forehead.

In the photo on the right we see the scar in the hairline after a forehead lift.

6. The surgery

With the subcutaneous lift the skin is loosened from the forehead via an incision in the hairline and then lifted relative to the forehead muscle. The height of the forehead remains unchanged or decreases, which is an esthetical/cosmetic advantage. Another effect of the lift is that the grooves, that are often deep, will be gone. This is a very effective method, but it leaves a scar in the hairline. This scar, however, softens in time and will eventually hardly be visible especially when hair is worn slightly on the forehead. Because of the good results and the quick cure, I increasingly opt for this form of forehead lift.
The operation takes 1 1/2 hours and is performed under general aneasthetic.

With the endoscopic lift a small camera is used. Small incisions are made in the hair in order to detach the forehead skin and muscle from the scull bone after which the skin is raised and temporarily attached. In 3 weeks the forehead skin will attach itself to the skull bone of the forehead in the new position (2 to 3 cm higher). As stated, with this method the position of the hairline changes, leaving a slightly higher forehead and is particularly suitable for young people with a low forehead.
The operation takes 1 1/2 hours and is performed under general anaesthetic. 

With the small or direct eyebrow lift, the skin with the underlying muscle is removed oval-shaped in the upper and outer side of the eyebrow. Only the outside is lifted with this technique and is therefore particularly suitable for hanging eyebrows as a result of aging.
The operation takes 30 to 45 minutes and is performed under local anaesthetic. 

7. After the surgery

After the subcutaneous and endoscopic forehead lift you will awake wearing a turban.

After the subcutaneous lift surgery you will feel good straight away without nausea or pain, so this procedure does not require an overnight stay. The next morning you can remove the bandages yourself and take a shower and wash your hair with shampoo. The stitches in the hairline will be removed in the polyclinic after one week.

With the endoscopic lift you might suffer from nausea and a headache. For the pain and nausea you will receive medication. You will be hospitalized for one night. The morning after the surgery the bandages will be removed and you can take a shower and wash your hair (but without rubbing your scalp). The stitches will dissolve automatically.

The scalp/forehead can feel ‘strange’ or ‘numb’ for a while, but this will slowly disappear. After two weeks you can pick up your normal activities if these are not too strenuous. 

The small or direct eyebrow lift is an outpatient procedure under local aneasthesia and can be compared with an eyelid correction. The stitches are removed after 1 week.

8. Complications

With the subcutaneous lift via the incision in the hair line a decreased blood flow around the scar can occur, causing a slower healing process and a wider scar (caused by an extremely high forehead, thin skin or especially by smoking). That is the reason that you have to quit smoking well in advance.

As mentioned above, with the endoscopic lift it is possible that there is a temporary decrease in the sense in the forehead. The chance of permanent nerve damage is extremely low due to the use of the mini camera. All in all no major complications are to be expected.

The small or direct eyebrow lift has no significant complications.

With all techniques bruises might appear around the eyelids. High blood pressure or the use of blood thinners increases the chance of this. An infection is rare with the forehead lift.

Dr. Erik J.F. Timmenga