Endoscopic Forehead Lift (Brow Lift)

Forehead Lift

•Brow lift (forehead lift) is a plastic surgery procedure which will raise your eyebrows to a higher and more aesthetic position. It will also improve lateral hoods (which are the droopy flaps of skin that hang over the outside corner of your eyes. Plastic surgery of your forehead will also soften your horizontal forehead wrinkles and the scowl lines between your eyebrows.
•A brow lift will NOT improve baggy eyelids, puffy eyes, or crows feet. Consider eyelid surgery or wrinkle treatments for these problems.
•Scars from a Brow Lift
•May be on top of the head or in front of the hairline, depending on the technique chosen (see Brow Lift Options below).

Brow Lift Options

Brow lift may be performed in several ways. There are three commonly used techniques (Hint: if your surgeon suggests a technique which is not similar to one of these, then go elsewhere). The options are coronal lift, endoscopic lift, and subcutaneous lift.

A coronal forehead lift involves an incision across the top of your head, from ear to ear. Through this incision, your surgeon can alter the muscles (frontalis, procerus, and corrugators) that cause horizontal forehead wrinkles and scowling. After doing this, your surgeon will actually remove about a 1-2 cm strip of your scalp and sew the remaining scalp together. Although this may sound gruesome, it is the oldest and most reliable technique in brow lift surgery. The main disadvantage is that you will be numb on the top of your head for about six months, after which time the sensation usually returns. This technique also raises your hairline, which can be a problem for those with a high forehead who also wear their hair back. The advantages of this technique are that it is lasting (it will not have to be repeated as you age, with very rare exceptions). Also the scars are concealed behind the hairline and are not seen after they heal (unless you are a man with a receding hairline, in which case you should not have this kind of brow lift).

Endoscopic forehead lift involves four to six short (one inch) incisions behind your hairline. Through these small incisions, your plastic surgeon inserts and endoscope which has a tiny camera on the end. This allows her or him to see under your skin without making a long incision across the top of your head. Through this technique, your plastic surgeon will be able to do most of the things that can be accomplished through a coronal lift with a few notable exceptions. Your plastic surgeon will be able to weaken the scowl-causing muscles but will not be able to directly alter the muscle that causes horizontal wrinkles. Also, your plastic surgeon can lift your forehead, but does not remove the excess scalp. She (or he) merely shifts it upward and backward on your skull. To secure your scalp into its new position, your plastic surgeon may drill small hole into your skull and place tiny screws (which later are removed or which are absorbed by your body). Even with these screws, because excess scalp is not removed, there exists greater potential for your forehead and brows to droop after an endoscopic lift. (Relapse is most common in those with very droopy brows and very deep creases.) Because endo lifts have only been performed since 1995, no one knows exactly how long the results last. Finally, endo lifts, like coronal lifts, raise your hairline, but (unlike coronal lifts) they do not cause temporary numbness on top of your head.

Subcutaneous forehead lifts are the least commonly performed of all brow lifts. In this technique, your plastic surgeon makes an incision across the top of your forehead, where your hairline begins. All of the muscle alterations that are performed through a coronal lift are possible through this operation. Also, your excess skin is removed. Because the incision is in front of the hairline, your hairline will not be moved higher (unlike the other two techniques). Also, you will not have numbness on top of your scalp. The major disadvantage of this technique is that it leaves a scar across the top of your forehead, which can be highly visible (see brow lift photos). To conceal your scar, you will need to wear your hair forward. If you are wearing your hair forward, then it doesn’t matter as much how high your hairline is because your hairline will not be visible. Hence, you could have had a coronal lift or endo lift in the first place. Think about it.

During and After your Brow Lift

Anesthesia: sedation or general.
Location of operation: Office or hospital.
Length of surgery: 30-90 minutes.
Length of stay: Outpatient (home same day).
Discomfort: Mild; anticipate 0-4 days of prescription pain medication. 
Swelling and bruising: Improve in 10-14 days. You can reduce swelling through constant head elevation and frequent application of ice. You may develop black eyes temporarily. 
Bandages: Removed in 1-3 days.
Stitches: Removed in 7-10 days. 
Contact lenses: May be worn in one week.
Make-up: May be worn in 3-5 days.
Presentable in public: 7-14 days, with the help of make-up.
Work: You may feel capable of returning within 3 days, but your appearance will be the limiting factor. 
Exercise: May be resumed in 2 weeks. 
Final result: Seen in 2-4 weeks.
•Ask your surgeon about 
these possible complications and telltale signs
•Forehead paralysis
Brow asymmetry
Permanent loss of hair 
Numbness of the forehead
Early relapse
The surprised look
High hairline
•Average Cost of a Forehead lift (in the U.S.)
•Surgeon’s Fee
Anesthesiologist’s Fee
Operating Room Fee
Total$ 2,600
$ 600
$ 800
$ 4,000(The above listed fees do not reflect those of Dr. Loftus. For a complete listing, visit Fees at The Loftus Plastic Surgery Center.)

Tips and Traps

•Do not believe anyone who tells you that an endoscopic brow lift lasts 20 years (this myth is sprawled all over the internet). This procedure has only been around since 1995, so there is no way anyone can predict that it will last 20 years. So far, we know that it lasts at least five years in many people, but others have had to have another lift because their first one did not last this long. By the year 2015, we will know more. My guess is that we will find that it lasts 5 years in 80% of people, 10 years in 60%, 15 years in 40%, and 20 years in 20%. This is just a guess, but will probably be close to the truth.
•If you have mild to moderate brow droop and horizontal wrinkles, an endoscopic lift may be a good choice.
•If you have advanced brow droop with deep wrinkles, a coronal forehead lift may be most appropriate.
•If you have a high forehead, the solution is not simple. To avoid raising your hairline further, you may want a subcutaneous lift, but this will give you visible scars. You need to decide which is worse. Wearing your hair forward will conceal either problem.
•Do not expect a forehead lift to improve your baggy eyelids or crow’s feet.
•Quit taking aspirin and ibuprofen for two weeks prior to surgery. Discuss all of your non-prescription medications with your doctor.
•Sleep in a recliner or with your head elevated on pillows for the first several days after surgery to minimize swelling. Frequent application of ice is also important.

Dean Plastic Surgery