A forehead lift, also known as brow lift, is a surgical procedure by which a person’s forehead skin and the muscle tissues along with the brow line are lifted to provide a younger look. As a person ages, due to time and gravity, the forehead skin gives in to wrinkles and frown lines with the eyebrows drooping. This may produce signs of tiredness, sadness or anger in a person’s face even though he may be having quite opposite feelings.

Usually, people in the age range of 40 to 60 go for this procedure to improve on their forehead and brow conditions.

The earliest reference to forehead lift in the modern era may be traced to a medical discussion written by a German surgeon Eric Lexer on the procedure in 1910. Since Lexer’s time to 1950s, the surgical procedure known as open or coronal forehead lift was used in which a long incision on the scalp followed by lifting and tightening of the skin and muscle were done. The open surgery is practised even now with modern anesthetic, skin tissue fixation and other techniques.

A forehead lift is sometimes combined with upper eye lid surgery to be followed by lower eyelid surgery to improve the appearance of the upper facial area.

Procedure  Sincetheentry of hugely popular Botoxinto the market fortreatment for wrinkles, there has been demand of minimally invasive surgery. Endoscopic forehead lift is now often adopted by several surgeons. Of note, if one has excess drooping of the forehead skin and needs a forehead lift, Botox may cause a problem due to relaxing of the forehead muscles resulting in potentially further drooping. Thus, consultation with a knowledgeable cosmetic physician regarding Botox use is recommended before undergoing Botox treatments.

In the conventional surgery for a forehead lift, ear to ear incision on the scalp inside the hairline is followed by lifting of the skin with muscles from the underlying tissues. The skin and the muscles are then pulled up towards the head and the extra tissues are trimmed off. The incision line is then closed by sutures.

In cases where the forehead skin and the eyebrows are not very heavy, a conventional surgery alone is enough to lift the forehead, brows and the upper eyelids giving the patient smoother, refreshed and pleasant looks.

In the endoscopic surgery, one thin arm fitted with a lighted camera and two to four other thin arms of the endoscope, are inserted through small three to five 3/8 inch long incisions in the scalp. The surgeon can have views underneath the skin on the TV screen and can carry out the grasping and cutting actions using the surgical tools carried on the endoscope arms while watching the TV images to guide his movements.

Advancement in the endoscopic procedure is achieved through a fixation device called Endotine which is a bio-absorbable implant. Through this device, the surgeon is able engage the skin and muscle on the implant and get the flexibility to re-adjust the height of the lift, if required. The lifted tissues heal up within 30 to 60 days with the underlying layers, if not disturbed, with the Endotine being finally absorbed by the body.

The forehead lift procedure may be done on out-patient basis with local or general anesthesia. The procedure takes about one to two hours.

The cost of the forehead lift surgery ranges from $3500 to $ 5000. The insurance companies normally do not cover the cost as they consider the surgery as cosmetic.

Recovery- The patient has to keep the head raised for 2 to 3 days after the surgery to prevent too much swelling. Some swelling and bruising will be there for a few days. The patient can walk around after 1 or 2 days and go back to work after about 10 days. Vigorous physical activity should be avoided for several weeks and contact sports for about 6 to 8 weeks. Exposure to sun and heat should be avoided for several months.

Risks-

i) Forehead lifts may occasionally make raising of eyebrows or wrinkling of the forehead on one side or both sides, somewhat hard. In such cases more surgery may be needed to fix it.

ii) Forehead lift is not recommended in case an upper eyelid surgery has already been done, as this may interfere with the ability to close the eye lid.

iii) Though infrequent, there may be complications such as infections, fluid accumulation, bleeding, skin  damage. Choosing the right plastic surgeon with experience in forehead lift surgery and following up on his advice pre- and post- surgery help in reducing the risks

iv) The patients with Endotine implants have risk of moving their newly adjusted tissues with relatively small movements before complete healing. Also, Endotine may not support thick tissues and brows well. The patients should be cautious about their movements and should consult with the surgeon on these issues.

v) Hair loss may occur in the scalp along the incision/ scar line. The patient should consult with the surgeon on this issue also.

[Source: http://en.wikipedia.org/wiki/Forehead_lift http://www.nlm.nih.gov/medlineplus/ency/article/002990.htm]