What is the purpose of a forehead lift?
A forehead lift
can lift the eyebrows, remove or diminish forehead
wrinkles and frown lines, smooth the forehead,
and/or reposition the hairline.
How is the forehead lift done?
1. The behind the hairline incision:
The forehead lift
can be done with an incision behind the hairline or
at the hairline. If it is done behind the hairline
the incision does not show at all, but there can be
some loss of hair, especially along the incision
line. In women or patients with a full head of hair,
the incision is usually hard to find.
This technique can
and usually does lift the hairline back, thus
causing the appearance of a taller forehead. In the
more rare instance of a hairline that is too low on
the forehead, it can be beneficial to the appearance
to shift the hairline back, creating a higher
2. The hairline incision:
If the incision is
placed at the hairline it is called a hairline
incision. If the skin is beveled, the hair can grow
through the incision line, thus hiding it. When the
incision is smooth after healing and the color is
the same as the skin, it is usually invisible.
The advantage of
this technique is not to lose a single hair. Most
people want every hair on the head, especially as
they age. When people are young this may not seem
important, but the hair may become thinner in both
men and women in time.
3. The endoscopic forehead lift:
An endoscope is a
small pencil-sized tube that allows the surgeon to
see inside the body through a small incision. It can
be used anywhere in the face and is most popular for
use in the forehead procedures.
A variation that
has come with the endoscopic technique is to anchor
the lifting suture to the skull with small sterile
screws placed in the skull. This is a technique we
do not use.
The eyebrows can
be placed in the most attractive position (or as
desired) without using screws in the skull or
requiring an endoscope. For the best results, these
tools are not required.
A small incision
can be done with or without an endoscope. The
techniques we use that hold the eyebrows in the
position of choice do not require screws in the
skull and yield better results.
The endoscopes are
fun to look through or to see on a TV monitor. But
this would be like looking at road with binoculars
while driving the car. Distance vision is
undoubtedly improved. However, the driver has many
more things to look at and to consider than the
magnified image. The endoscope is much like this for
the surgeon. In using it, the surgeon loses site of
many important things, such as the goal of the
Nothing can be
accomplished cosmetically with an endoscope and/or
screws that cannot be done better without.
What problems occur with forehead lifts?
The most common
problem is a startled look from lifting the
eyebrows. Several pictures of persons who have this
result and regret the operation are shown under therevisions or forehead section
of this web site.
The next most
common appearance problem is to have the hairline of
the forehead stretched too far back, making the
forehead look too high.
In the Los Angeles
area, the procedure of forehead lift has been very
popular over the past 20 years. Some persons who
have had it done looked better before surgery.
Look critically at
each surgeonís before and after pictures and these
problems will be seen. Either the eyebrows are too
high, giving a "surprised to see you" look, or the
hairline has been shifted back too far and the
forehead looks too long and large - or both.
The other problem
that cannot be seen is numbness. This numbness may
extend to the top of the head and last months or
years. The occurrence of this problem depends on how
the surgery was done, and in most cases we can
A common problem,
especially when a screw is used above the hairline,
is that the result is not long lasting. Often, in
only 2-3 years the eyebrows are at the same level as
How much improvement can one expect?
This is a
crucially important question. The best answer is to
see the improvement in advance.
Generally this can
be seen in the pictures of the faces that are shown
here on this web site and the many others that we
can show in the office that are not on this web
But in your
specific face the best answer is to see the
improvement in advance. Looking in the mirror with
the doctor and holding the tissues of the forehead
in more attractive positions is the standard
traditional way of seeing how much improvement can
be obtained in the face. This is simply done by
holding the forehead tissues up and back or in
whatever position looks best.
We also answer
this question for each person by using drawings. The
drawings should be of good enough quality that the
answer can be clearly seen. It is much like trying
on clothes; you can see how they look on you.
And with the
drawings, the patient can take them home, and hang
them up on he wall and look at them when in
different moods. And her or she may get the opinion
of others as to which looks best or how much
improvement there is or can be.
Then there is the
question of how close the post-surgical appearance
is to the drawings. You can see that for yourself by
looking at any of the thousands of photographs of
befores and afters and comparing them to the chosen
We also have the
opinions of hundreds of our patients who have had
work done. A majority say that the results equal or
exceed the drawings. You may see hundreds of these Results
the summaries of the answers to these questions.
Anything that can
be done with the fingers on the face such as lifting
up and back or lifting eyebrows or the corners of
the eyes up and back can be done with surgery. In
effect, this is a preview. And even without
drawings, most doctors look in the mirror with the
person and discuss the possible changes and
improvements in the mirror. Often, it is good to see
that you and the doctor agree more or less on what
is possible and most advantageous.
The drawings have
an advantage over looking in the mirror in that they
can take more details into consideration, they can
show more at one time, and they are more objective
in that they can be studied and critiqued by anyone,
anytime, and anywhere even without the subject being
there. And they are much more permanent. In king
Tut's tomb, the drawings would have lasted thousands
of years if the tomb remained undisturbed.
There is permanent
improvement and temporary improvement. It is a good
thing to emphasize and plan for the permanent
changes of shape and form over the temporary. The
face-lift is mostly temporary compared to the many
changes that can be made and chosen in drawings that
are permanent. We can make many persons appear
permanently younger and more attractive without a
face-lift. And those things can be explained to each
person and shown to them in drawings.
The amount of
improvement is quite different for each person. The
best estimate is with drawings. Looking at a lot of
the results of surgeon's works in before and after
photographs is a very good way of getting a general
idea of what can be done. Beware of retouching of
photos, especially those that are digital. Seeing
actual film prints, slides and negatives in a
doctorís office is more of a sure thing.
How long will the improvement last?
Those aspects of
the face that are changed in shape such as the nose,
cheeks, chin and even the eyelids and removal of
bags around the eyes are very long lasting or even
Those things that
are accomplished by tightening and repositioning the
skin are much more temporary. And so, tightening the
skin of the face with a standard face-lift by itself
may take 5 to 20 years off the personís appearance
in age. One way to express how long improvements
will last is to say that if it takes 10 years off
oneís appearance, the person will always look 10
years younger than if they had not had it done. And
so it will take 10 years for their appearance to
catch up to what it was in the beginning before
anything was done.
Thus, by that
formula, however much younger a person looks in
years is how long it will last. But on the other
hand, even the tightening up or face lift is
permanent in the sense that the person who looks 5
or 10 years younger will always look
that much younger, no matter how many years go by.
No operation can
permanently prevent aging, but the individual never
appears as old as s/he might have if the operation
had not been done. The exact duration of improvement
can be most accurately predicted with drawings that
show the expected result.
In Summary: The
improvement is permanent in terms of the change in
shape and structure, such as of the chin, under
chin, nose, etc. Some looseness of the skin always
returns. If a person is made to appear five or ten
years younger, they should always appear that much
younger than if they had not had the surgery. This
effect is cumulative, in that if a person has two or
three procedures, each causing them to look five
years younger over a period of time, they may look a
total of fifteen years younger as a result.
How is the surgery done?
The surgery is
performed with the patient in a twilight sleep. The
patient is given sedatives, tranquilizers and
medicines to prevent any feeling of discomfort. Our
anesthesia questionnaire shows that more than 94%
say they had a pleasant experience.
With the person
comfortable and mostly sleeping soundly, the work is
done as planned with small sterile instruments made
for this purpose. All of the instruments and
equipment used are sterilized.
While surgery is
in progress the person is connected to a pulse
oximeter, automatic vital signs monitor, and
electrocardiograph. But most important of all, the
person is always under direct observation of the
surgeon and his nurses and assistants.
Where is the operation performed?
It may be done in
the federally approved, Medicare certified,
outpatient surgery center of our office, or in the
hospital. Most persons choose the office because it
is more convenient and it offers greater privacy and
safety with less chance of infection, and patients
can avoid the added cost of a hospital bill.
We have had an
occasional patient have consultation and laboratory
work at the hospital both before or sometimes after
a surgical procedure.
But from the
surgeries performed in our outpatient surgery center
over the course of thirty-plus years, we have had a
perfect safety record and there have been no
there much swelling or bruising?
There is some
bruised appearance in nearly every case. Usually
this can be hidden by make-up within a few days or
in one or two weeks. It is mostly gone in three
weeks. Many procedures can be done without bruising.
there much pain?
No pain should be
felt during surgery. After surgery there is a
feeling of tightness and tenderness of the area for
a few days. Our anesthesia
has been filled out by every patient after surgery
over the course of many years is available for your
information. It shows that well over 90% are pleased
with the experience.
Will insurance pay for this kind of surgery?
surgery is rarely covered by insurance.
How long does the operation take?
may require several hours.
Are bandages worn on the face?
In most cases no
bandages are needed. If they are used, they will be
removed the second day following surgery. We find
that little plastic drains that cannot be felt by
the person are much more comfortable than bandages
When are the sutures removed, and is this painful?
Some sutures are
removed within the first week. Some sutures are
removed each time you are seen over a period of one
to several weeks. There is no real pain with suture
removal. Each suture removed may feel like one hair
being plucked from the head and should not even feel
that much. Usually there is no sensation or just a
tickle with suture removal.
Are there any scars?
should produce no scars and no signs that it was
ever done. The location of the incisions can
be drawn on the patient to show where they will be.
Most patients heal well and do not have any visible
We can almost
always eliminate any visibility of scars if they do
Must some of the hair be shaved? Is any hair lost?
No hair is shaved,
and no hair is lost. Very rarely, there is a low
forehead hairline that is wished to be set back.
Yet some surgeons
still make incisions behind the hairline and
routinely remove precious hair. This eventually
leads to what is referred to as bald face, which is
a hairline that is pulled back too far, resulting in
hair loss and a long distance from the hairline to
the eyebrows and eyes. Many celebrities who are over
forty have this condition - and amusingly, some who
even deny ever having had surgery.
How long is the recovery period?
recovery is as follows: On the first or second day
after surgery the drains are usually removed. If any
bandage was applied, this is removed on the second
day. On the fourth or fifth day some sutures are
removed and make-up may be applied. Post-op visits
to our office are quite frequent in the first two
weeks to make you as comfortable as possible during
How long before I will be presentable in appearance
after a face-lift?
Usually one to
three weeks is required for sufficient healing. The
patient should expect noticeable signs of surgery in
the first week. With proper make-up after the second
week, most strangers you meet will not be able to
tell any surgery was done. In two to three weeks,
patients often wish to return to work. Complete
healing may require four to six weeks or more.
We have several
sets of very informative pictures donated by our
patients that show how they progressed through
having the face and eyes and other procedures done.
You may wish to see
them here on