Northern Virginia- Fairfax and Manassas
By: George Bitar, M.D. and Larry Lickstein, M.D.
Board Certified Plastic Surgeons
An open forehead lift that is well performed by an experienced plastic surgeon will accomplish rejuvenation of the upper third of the face and can be combined with a facelift to give full facial rejuvenation. A forehead lift accomplishes two main goals: lifting of the eyebrows to “open up the eyes”, and weakening the muscles of the forehead and between the eyes to smooth the wrinkles.
When someone looks in the mirror and is unhappy with their face, it can sometimes be difficult to verbalize why they are unhappy. Assuming that genetics and the aging process play a role in a person’s unhappiness with their appearance, it is important to identify the problem and offer a surgical solution:
- If a patient is unhappy with excess fat in their neck but has good skin tone and good muscle tone of their neck, then he/she is a good candidate for neck liposuction.
- If a patient is unhappy with excess fat in their neck and has loose skin and/or muscle in their neck, then he/she is a good candidate for a neck lift.
- If a patient is unhappy with laxity in their neck as well as their jowls and jaw line then he/she is a good candidate for a mini facelift
- If a patient is unhappy with their neck, jowls, and cheeks then he/she is a good candidate for a facelift.
- If a patient is unhappy with droopy eyebrows and wrinkles in the forehead then he/she is a good candidate for a forehead lift.
Preparing for Surgery
An initial consultation is set-up where we discuss the forehead lift procedure and whether you are a good candidate for the surgery. Your medical history is reviewed, and you will be asked to see your medical doctor for a physical check-up and a few labs to make sure you can undergo the surgery safely. You are asked to stop smoking, if you are a smoker, two weeks before and two weeks after surgery, for the surgery to be performed safely, and for you to have optimal results. You are given the opportunity to talk to patients who have had the same surgery that you are considering. We will see you shortly after the surgery (in a day or two usually). You are seen regularly after your surgery. You are always welcome to come back for follow-up, even years after your surgery, free of charge.
The Forehead Lift Procedure
There are four main ways of rejuvenating the forehead.
1. Botox to the forehead muscles and between the eyes, coupled with an upper eyelid lift.
Since Botox has become popular a few years ago, the number of forehead lifts has declined nationwide, since people now have a non-surgical option. Botox is excellent to smooth the wrinkles of the forehead, between the eyes, and in the area of the crow’s feet at the corners of the eyes. The injection is relatively painless, quick, and gives temporary relaxation of the muscles that smooth wrinkles for about 4-6 months. If the upper eyelids are heavy with excess skin and/ or fat, then combining an eyelid lift with Botox injections may give results approaching those of a forehead lift with less downtime and with a simpler procedure. The disadvantage of this procedure is the fact that Botox has to be repeated about twice a year.
2. Lateral Browpexy with Upper Lid Blepharoplasty
Minimally invasive procedures have increased in popularity as a result of their effectiveness and the ability to have them performed under local anesthesia with light sedation. Good results with less down time are the primary reasons for this trend. This procedure is performed by making two small incisions behind the hair line and lifting the arched part of the brow to rejuvenate the upper face. Excess skin removal of the upper lids is often combined with this procedure to address the heaviness of the face and upper eyelids. It addresses the tired look that many patients often complain about. The only downside to this procedure is that the results of the correction are more subtle and if you have frown lines between the eyes Botox or Dysport may still be required.
3. Endoscopic forehead lift.
This is a forehead lift that is accomplished with 3 small incisions in the hair-bearing area of the forehead. The skin is pulled upwards but not cut out. The skin is then fixed in the new location with either screws, glues, or other means. Our experience with endoscopic forehead lifts has been disappointing, since the skin has sagged again after a few months to a year, negating the nice results obtained early on with this procedure. For this reason, we perform the open forehead lift.
4. Open forehead lift.
This procedure sounds more involved than it really is. The forehead and frontal part of the scalp is elevated with a scalp incision extending from ear to ear and is well hidden in the scalp. No hair is shaved or lost. A strip of scalp skin, about one inch wide, and the length of the incision, is cut. The muscles in the forehead and between the eyes are weakened. The skin is then pulled up and sutured resulting in a nicely hidden scar. The procedure requires about 2 hours and gives nice long-term results, since skin is removed and a good repositioning of the eyebrows is accomplished.
Benefits of the Open Forehead Lift Technique
- Very natural results without a "done" look.
- This forehead lift technique is moderate in terms of aggressiveness. It provides an excellent long-term result (about 7-12 years) with a low risk of major complications.
- The scar is very nicely hidden. In most cases, it is difficult to appreciate it. Hair is not shaved, and the hairline is not raised.
- This technique is flexible and can be adjusted to different scalps with varying amounts of fat, laxity of skin, and laxity of muscle, with excellent long-term results.
Disadvantages of this Open Forehead Lift Technique
- This technique will leave the patient with a scar of the scalp from ear to ear. In a person with thinning hair, or scalp baldness, the other two options may be better.
- This technique leaves the crown of the head with permanent loss of sensation, since the nerves are cut. This is usually not a deterrent for having the surgery, but every patient has to decide for him or herself.
- The operative time, healing time and pain are probably comparable to the endoscopic technique, but to some, this may seem to be a more involved procedure.
How We Minimize Complications of Forehead Lifts:
At the Bitar Cosmetic Surgery Institute, we take pride in making sure we provide for our patients the best surgical experience possible , anticipating problems or set-backs, and addressing them before they happen. This is a process that includes the pre-operative preparation, the actual surgery, and the after care.
General complications can occur with any surgery. Cosmetic surgery is usually a safe surgery performed on healthy patients and, as all surgeries go, is with low risk. What we do to even lower the risk of complications is to operate at a first class hospital with board certified anesthesiologists and nurses. To avoid post-operative complications, we advocate early mobilization –patients seen in our office one or two days after surgery- and active participation in their own post-operative care. When we create a partnership, the results invariably improve.
Bleeding after a forehead lift is rare. Before surgery, our patients are tested to make sure they don’t have any common bleeding disorders by their own physicians, and by lab tests.
Infection/ Open Wound
The most important step in avoiding infections, in our opinion, is to perform the surgery at a first-rate surgical facility with board certified anesthesiologists and nurses. Patients are given the appropriate intravenous antibiotics coverage throughout the surgery. During the surgery, the skin surface of the patient is cleaned properly. After the procedure, our patients are prescribed a one-week course of antibiotics to minimize infection. As a result of these extra precautions, our rate of infection after a forehead lift is extremely rare. If there is a small wound, the blood supply to the forehead is excellent, and healing occurs rapidly.
In our forehead lift technique, we do the dissection away from the major nerves to avoid injury. The result is a minimal rate of functional nerve injury. There is sensory nerve damage, with some loss of sensation of the scalp. Sometimes, temporary loss of sensation from a “stunned” nerve or a bruised nerve may occur in the time period after surgery.
The "Surprised" Look
With any forehead procedure, there could be a period, early in the healing phase, where a patient may look like they are surprised. This is due to the swelling and early skin tightness that relaxes with time. Reassuring the patient that this look is temporary usually puts patients at ease.
Any procedure that causes the forehead stress may lead to hair loss, which is usually temporary. This is a rare occurrence, and one that we have not experienced in our practice, but is listed to remind people that certain complications are associated with the forehead lift procedure.
Our office will provide you with a detailed post-operative instruction sheet that will be individualized to your needs. We usually see patients the day after surgery in one of our offices to make sure that everything is O.K., and that you are healing as planned. Multiple visits in the year after the procedure will ensure the best outcome possible.
For more information about this procedure call our office and speak to our friendly staff member at 703-206-0506.
Information on this web site is for information only. Do not use the information to diagnose or treat your plastic surgery or cosmetic surgery problems. Please contact your plastic surgeon with all questions and concerns.