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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 forehead. 

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 operation.

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 prevent it. 

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 before surgery. 

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 site. 

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 drawings. 

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 Questionnaires and 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 permanent. 

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 emergencies.

Is 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.

Is 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 questionnaire that 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?

Strictly cosmetic surgery is rarely covered by insurance.

How long does the operation take?

Careful surgery 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 needed. 

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?

Cosmetic surgery 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 scars.

We can almost always eliminate any visibility of scars if they do occur. 

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?

The average 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 your recovery.

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 the website.

 

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 William Roy Morgan, M.D., F.A.C.S  Last modified: January 22, 2015