Plastic Surgery Specialists - Dennis T. Monteiro, MD, FACS  
 
   
   
Brow/Forehead lift


Because your face is one-of-a-kind, your browlift procedure needs to be fully customized to address your unique needs. Dr. Monteiro will create an individualized approach to correct the effects of aging on your face. His techniques can refresh your look and soften wrinkles without appearing tight or unnatural.

Please ask Dr. Monteiro about anything you don't understand.


Browlift procedure


If you are considering a browlift...

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 browlift, 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. Your surgeon may use the conventional surgical method, in which 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 youthful appearance.

Often a browlift is done in conjunction with a facelift, eyelid surgery, or nose reshaping.




The best candidates for a browlift/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. For these patients, endoscopy may be used to perform a brow lift, minimizing scar lines.The surgeon will simply alter the incision location or perform a more conservative operation. 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 discuss them in detail with Dr. Monteiro.


Before the procedure:



A browlift can smooth the forehead, raise the upper eyelids, and minimize the frown lines that come with aging.

Sometimes an upper and lower eyelid-lift or a facelift is performed with a browlift to inprove the overall cosmetic improvement.



 



All surgery carries some uncertainty and risk.

Complications are rare in a browlift and are usually minor when a forehead lift is performed by a qualified plastic surgeon. 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.

For some patients, particulary those individuals who are bald, or have thin hair, endoscopy may be used to perform a brow lift, minimizing scar lines.

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, your surgeon 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.

 






Planning your surgery

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. Then 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 consultation, Dr. Monteiro 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 the doctor if you have had previous facial surgery, if you smoke, or if you take any drugs or medications - including aspirin, certain vitamins, or other drugs that affect clotting.

If you decide to proceed with a browlift/forehead lift, Dr. Monteiro will explain the surgical technique, the recommended type of anesthesia, the type of facility where the surgery will be performed, the risks and the costs involved. Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results of surgery.






Preparing for your surgery...

Dr. Monteiro 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.
If your hair is very short, you may wish to let it grow out before surgery, so that it's long enough to hide the scars while they heal. 

Whether your forehead lift is done in an outpatient facility or in the hospital, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two.







Where your surgery will be performed?

A forehead lift is usually done in Dr. Monteiro's office-based facility; however, it is occasionally done in the hospital.







Types of anesthesia

Most facelifts are performed under local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and your face will be insensitive to pain. (However, you may feel some tugging or occasional discomfort.) Dr. Monteiro may choose to administer a general anesthesia. In that case, you'll sleep through the operation.








The Surgery

Dr. Monteiro
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 your surgeon recommends and why he or she feels it is best for you.

The classic brow/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. 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.

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. Monteiro may recommend a mid-scalp incision so the resulting scar follows the natural junction of two bones in your skull and is less conspicuous.

1. In preparation for a forehead lift, the hair is tied back with rubber bands in front of and behind the incision area. An incision is usually made across the top of the head, just behind the hairline.
   
 

2. Forehead skin is gently lifted and portions of facial muscle and excess skin are removed.
The incision is then closed with stitches or clips.


   

The incision is then closed with stitches or clips. Your face and hair will be washed to prevent irritation and the rubber bands will be removed from your hair. Although some plastic surgeons do not use any dressings, your doctor may choose to cover the incision with gauze padding and wrap the head in an elastic bandage.

The endoscopic brow/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, your surgeon will make three, 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 the surgeon 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 temporary fixation screws placed behind the hairline.

When the lift is complete, the scalp incisions will be closed with stitches or clips and the area will be washed. Gauze and an elastic bandage may also be used, depending on your surgeon's preference.




After your surgery...


The immediate post-operative experience for a patient who has had a classic forehead lift may differ significantly from a patient who had the procedure performed endoscopically.



Getting back to normal...!

Although you should be up and about in a day or two, plan on taking it easy for at least the first week after surgery. You should be able to shower and shampoo your hair within two days, or as soon as the bandage is removed. Most patients are back to work or school in a week to 10 days. 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 concealed with special camouflage makeup. You may feel a bit tired and let down at first, but your energy level will increase as you begin to look and feel better. Dr. Monteiro can answer any questions you may have during your recovery period.








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.

A forehead lift can smooth the forehead, raise the upper eyelids, and minimize the frown lines that come with aging.

Having a browlift/forehead life doesn't stop the clock...but it can minimize the appearance of aging for years.