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| Forehead lift |
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 Figure 23-a (click image to enlarge) |
 Figure 23-b (click image to enlarge) |
 Figure 23-c Ten years after surgery. (click image to enlarge) |
The forehead lift or upper face lift, with its various modifications, became popular in the late seventies.
The incisions are usually hidden inside the hair line, although in some instances, may be placed along the hair line on the forehead. The skin of the forehead and eyebrows is lifted. The muscles responsible for creating forehead and between the eyebrow wrinkles are divided under the skin.
This operation has gained great popularity mainly because of the inconspicuous scars, relatively few side effects, and minimal immediate post-operative discomfort. It is frequently used for young females who have a habit of wrinkling their foreheads and whose low positioned eyebrows produce a sad and tired appearance. It is particularly effective in the older age group where sagging of the eyebrows produces hooding of the upper eyelids.
The operation is performed under local freezing with sedation. The patients are requested to shampoo their hair the night prior to their surgery. There is no shaving of the hair required. Some of the hair bearing skin will be removed during the operation unless the incision is placed along the hairline on the forehead when non hair bearing skin is removed. This latter technique is designed to prevent the tendency for post-operative lifting of the hairline.
Some of the hair will be cut during the surgery and will remain in the scalp to fall out during the first two hair washings after the operation. This should not alarm you as a sign of losing your hair. The incision is closed by metal staples which are removed between the seventh and twelfth day following the operation with less discomfort than suture removal. You can wash your hair on the third day, combing it gently with your fingers to avoid catching on the staples along the incision line. You should not dye your hair for three weeks after the surgery and therefore it is advisable to do it a few days prior to the operation.
Figure 23-a (click image to enlarge) |
Figure 23-b (click image to enlarge) |
Side effects and possible risks
Swelling around the eyes and forehead, moving to the lower face with discolouration around the eyelids, usually subsides within ten to fourteen days.
In order to obtain satisfactory smoothing and elevation of the forehead, the eyebrows will be positioned higher during the immediate post-operative period than the level at which they will settle three to four months later. As a result of this operation the forehead may appear to be higher because of the lifting of the hair line. Request to see some examples during your pre-operative visits and you will notice that this change is aesthetically acceptable and, in many instances, to the patient's benefit.
The scalp scar may continue to cause some itchiness at times, lasting up to six months. This has been reported by the patients but has never caused any great discomfort. A certain amount of numbness around the scar will be experienced. Permanent numbness of the forehead has been reported as a complication of this operation, but not experienced in my practice.
One of the purposes of this procedure is to eliminate voluntary and involuntary movements of the forehead responsible for the formation of grooves and wrinkles. Such movements, to some extent, will return within six months but will be less vigorous and less damaging to the skin.
On rare occasions, small patches of baldness have been reported in the line of the scar. They are inconspicuous after combing the hair and can be removed or tufts of hair can be grafted into the affected area under local freezing.
The results of the forehead lift are gratifying and the operation is often performed in young individuals to create a more rested "open eye" appearance.
Endoscopic forehead lift
A new technique in all surgical specialties was developed in the eighties. With the use of special instrumentation, surgeons are able to perform procedures inside the body cavities without making large incisions. It is extremely useful in abdominal, lung, orthopedic surgery. It has become one of the fastest developing techniques in facial plastic surgery, especially in corrections of the forehead and mid face. Whereas many surgeons use this method, it has certain limitations and is not suitable for every patient. The choice of this technique will depend on the age of the patient, and hairline and eyebrow configuration.
The direct eyebrow lift - mid-forehead lift
The indications for these operations are the same as for the forehead lift. The technique differs mainly with regard to the placement of the incisions and the treatment of the forehead muscles. It is still performed by some surgeons. I prefer to discourage these procedures because of the unpredictability of the scar formation that exists in every patient.
