Brow, Forehead & Cheek Lifts

Pre-Forehead Lift Diagram

In a traditional forehead lift, the surgeon tightens the forehead and lifts the eyebrows by removing a strip of skin at the top of the forehead or within the hairline.  Placement of the incision is determined by the height of your existing forehead. If you have a short forehead with a low hairline, then the incision can be camouflaged within the hair bearing scalp across the top of your head. This is a very traditional procedure called a coronal forehead lift and probably describes the surgery that most people envision when they think of a forehead lift. For patients with a normal to high hairline, the incision can also be placed just inside the hairline at the top of the forehead. This is called a pre-tricheal skin excision, because it is placed “before the hair.” With careful technique, the surgeon can cut and sew the tissue so that the first few hairs grow through the scar. It is also called a trichophytic incision, which means that the incision is designed at an angle to preserve the hair follicles. With good technique and successful healing, you can likely comb your hair back several months after surgery with minimal visibility of the scar.

The principal advantage – it requires no special equipment and can even be performed under local anesthesia in the office.

The primary disadvantage – the long horizontal incision predictably causes numbness in the scalp behind the incision. This numbness may be permanent.

Pre-Endoscopic Forehead Lift Diagram

In an endoscopic forehead lift, the surgeon elevates and smooths the forehead through four tiny incisions in the scalp, using an endoscopic camera rather than direct vision. The endoscopic technique smooths the forehead and raises the eyebrows with the least visible scarring. The incisions are completely behind the natural hairline. The surgeon elevates (loosens) the skin of the forehead and the scalp from the bone using small instruments and a video camera passed through one or more of these incisions. The forehead is pulled upward and secured in the new position. Small sutures or surgical staples are used to close the incisions.

The principal advantage –

• Ability to hide all of the incisions inside the hair
• All incisions are parallel to the sensory nerves in the scalp, which greatly reduces the risk of postoperative numbness in the scalp
• On some occasions, can also assist with lifting the cheeks
• Horizontal wrinkles are reduced by stretching the forehead from above

The primary disadvantage – 

• If you already have a receding hairline, this procedure will lift it even farther back

If you can improve the appearance of your upper eyelids or eyebrows by lifting your forehead with your hand, then you would probably benefit from a forehead or brow lift.  Place the palm of your hand and four fingers across your forehead, about a finger breadth above your eyebrows. While looking in the mirror, firmly raise your forehead and then release, to observe the difference. Does this reduce the   appearance of excess skin in the upper eyelids? If it does, then you may wish to consider a brow lift. Look again at your upper eyelids with the brow elevated. Do you still have excess skin in the upper lids? Does any part of your eyelid block your vision? If so, you may wish to discuss a blepharoplasty (upper eyelid surgery) with your doctor as well. A brow lift is commonly recommended for patients who request upper eyelid surgery.

This procedure is performed on patients in their thirties through eighties. There is no ideal in a Brow lift – skin type, ethnic background, degree of skin elasticity, individual healing, basic bone structure, as well as a realistic attitude are factors that should be discussed prior to surgery.

Depending on the extent of the surgery, the process can take anywhere from 2 to 4 hours.

We can either perform the procedure in-office under local anesthesia with an accompanying oral sedative or the procedure can be performed under general anesthesia at Stony Point Surgery Center (depending on patient preference).

Medicare and most commercial insurance plans will cover a brow lift only if medically necessary to restore vision.  If your eyebrows are so heavy that you cannot see above the horizon without struggling to hold your eyes open, then insurance is likely to pay for your surgery.

In addition to a consultation with a facial plastic surgeon, you should also schedule an appointment with your ophthalmologist, who will measure your peripheral vision. This is called a visual field test. By examining the visual field test and by carefully examining your eyes, the ophthalmologist will determine whether the obstructed vision is due to sagging eyelids, eyebrows, or due to a disease within the eye, such as glaucoma.

Botox Brow Lift Diagram

For younger individuals, the eyebrows can be temporarily improved with Botox (botulinum toxin), fillers, & skin care. If Botox is placed in specific locations, it may temporarily relax muscles and in turn allows eyebrows to pleasantly drift upward. This is referred to as a chemical brow lift. Botox may also be used to flatten the horizontal lines in your forehead. However, you must discuss this carefully with your surgeon, as relaxation of the forehead muscles may reduce your ability to lift the eyebrows, and even cause them to sag.

Botox Brow Lift Before and After