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Forehead Lift

As we age, our facial skin loosens and wrinkles, causing drooping brows as well as creases and lines that can make us appear angry, sad, old or tired. Anything that will cause the skin to lose elasticity will hasten the process, including sun exposure, weight fluctuations and heredity.

A forehead lift can address these problems by surgically altering the muscles and tissues that cause wrinkling and/or drooping in the area above the eyes. It can also help people of any age who have developed furrows or frown lines due to stress or muscle activity. People with inherited conditions, such as a low, heavy brow or furrowed lines above the nose can also achieve a more alert and refreshed look with this procedure.

To effect a more complete facial rejuvenation, forehead lifts are frequently done in combination with other procedures such as a facelift to firm and tighten skin on the entire face, upper eyelid blepharoplasty to lift and tighten drooping eyelids, or lower eyelid blepharoplasty to remove excess puffiness or wrinkled skin beneath the eyes. Dr. Kremer / Dr. Zettl may also recommend injections of collagen or other substances for deep creases in your forehead or frown lines between your eyebrows.

If you're considering a forehead lift, the following information will provide you with a good introduction to the procedure. For more detailed information about how this procedure may help you, we recommend that you schedule a consultation with Dr. Kremer / Dr. Zettl.

 What are some of the most common benefits of this surgery?

A forehead lift is usually quite successful at restoring a more youthful, refreshed look to the area above the eyes. While this procedure cannot stop the aging process, it can often make a person appear to be a decade younger than their actual age.

Most patients are pleased with the results of a forehead lift, no matter which surgical method was used. Often, patients don't realize how much the wrinkled, loose skin on their forehead contributed to the appearance of aging until they see how much younger and more rested they appear after the lift. The eyebrow shape may be improved, horizontal lines are much improved, and even vertical lines may be eliminated.

For a better understanding of how a forehead lift might change your appearance, look into a mirror and place the palms of your hands at the outer edges of your eyes, above your eyebrows. Gently draw the skin up to raise the brow and the forehead area. What you see is close to what a forehead lift would do for you.

It is important that you realize that the texture of the skin will not be changed by a forehead lift. Acne scars, age spots, fine lines and smoker’s creases will soon return to their original texture, no matter how tight the skin is pulled. However, skin treatments such as laser resurfacing or chemical peeling can improve the texture of the skin, and these procedures are frequently used in combination with a forehead lift.

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 What will happen at the initial consultation?

During the consultation, you and Dr. Kremer / Dr. Zettl will discuss the changes that you would like to make in your appearance. Dr. Kremer / Dr. Zettl will explain the different options available to you, the procedure itself, and its risks and limitations as well as the kind of anesthesia required.

Dr. Kremer / Dr. Zettl will begin with a medical history and examine your face, including the skin and underlying bone. Be sure to tell Dr. Kremer / Dr. Zettl if you have had previous facial surgery, if you smoke, or if you take any drugs or medications, including aspirin, and if you have a tendency to form large scars or keloids.

Take this opportunity to ask all the questions you have about the surgery. Learning everything you can about your options, risks and benefits is the key to making an informed decision.

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 How is a forehead lift performed?

Depending on your situation, Dr. Kremer / Dr. Zettl may use the conventional surgical method, in which an incision is hidden just behind the hairline, or he may use a newer method which employs an endoscope, (a camera-like narrow tube with a bright light on one end) to achieve the desired results with minimal incisions. Before surgery, your hair will parted to reveal the incision line. Hair in front of the incisions will not be trimmed.

Method #1: Conventional forehead lift (also called a coronal browlift):

First, Dr. Kremer / Dr. Zettl makes an incision behind the hairline, from ear to ear. For men with a receding hairline, or women with thinning hair, the incision may be placed at the hairline instead, in order to avoid adding more height to the forehead. Next, the skin of the forehead including the frontalis muscle is lifted away from the underlying periosteum. The excess skin is trimmed away and the muscles are scored to treat dynamic wrinkles. The incision is closed with stitches or staples. Finally, Dr. Kremer / Dr. Zettl may cover the incision with gauze padding and wrap the head in an elastic bandage, which can usually be removed a day or two after surgery.

Method #2: Temporal forehead lift:

Access to the forehead is gained through an incision in the temporal scalp area on each side. These incisions are well hidden in the hair bearing areas and will be almost inconspicuous later. Through these incisions both the forehead can be smoothened out as well as excessive skin can be trimmed to tighten loose skin over the temples. These incisions can also elegantly combined with intraoral incisions in order to lift the mifacial soft tissues for a combined mid-facelift.

Method # 3: Endoscopic forehead lift:

This procedure is often preferred for younger patients who are just beginning to have brow problems. In this procedure, an endoscope is placed under the skin and muscles in order to get a clear view of the forehead tissues. Then Dr. Kremer / Dr. Zettl inserts another instrument through a separate incision to lift the forehead skin and remove or alter the muscles and underlying tissues. The forehead skin is tacked up in a higher position with skin staples and will heal in this position.

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 Will I need to stay in a hospital?

A forehead lift can be done in the hospital or in an outpatient surgery center, depending on your preferences, your health status and Dr. Kremer / Dr. Zettl’s judgement. Most forehead lifts are performed under general anesthesia.

You may be allowed to return home within a few hours of the surgery, and spend the night in the comfort of your own home, or it may be necessary to spend the night in the hospital so your recovery process can be monitored by a medical staff.

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 How much pain is there?

The amount of pain experienced varies from person to person, and depends on the method used. In general, more extensive procedures can give better correction of the aging changes in the face, but at the cost of greater operating time, more risk, longer swelling, slower recovery, and greater cost.

You should discuss your goals and pain tolerance with Dr. Kremer / Dr. Zettl in order to help him determine the procedure, or combination of procedures, that will produce the best results for you.

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 What can I expect after surgery?

The post-operative experiences for classic forehead lifts are usually quite different from those that are performed through the temporal approach or endoscopically.

In either case, you should keep your head elevated for 2 to 3 days after surgery to reduce swelling. You will be able to shower and shampoo your hair within two days, or as soon as the bandage is removed. You will probably be able to return to (sedentary) work within 7 to 10 days, sooner if you’ve opted for the endoscopic forehead lift.

Method #1: Conventional forehead lift:

After this procedure, you may experience some numbness and discomfort around the incision, which can be controlled with prescription medication. If you are prone to headaches, you may be given an additional local anesthetic during surgery as a preventive measure. Swelling may extend to the cheeks and eyes, although this should resolve within 10 to 14 days. As the nerves begin to heal, the numbness may be replaced by itching.

Method #2 und 3: Temporal and Endoscopic forehead lift:

After these procedures, you may experience some numbness, incision discomfort and mild swelling. Incision site pain is usually minimal, but can be controlled with medication, if necessary. Endoscopic forehead lift patients usually experience less of the pain and itching sensations experienced by those who have the classic forehead lift. The stitches or staples used to close the incisions are usually removed within a week, and the temporary fixation screws are removed within two weeks.

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 What is the recovery period like?

You may feel a bit tired at first, but your energy level will probably return to normal within a week. Most of the visible signs of surgery should fade completely within about three weeks. Minor swelling and bruising can be concealed with special camouflage makeup. For at least 2-3 weeks you should limit strenuous activities such as jogging, bending, heavy housework, sex, or any activity that increases your blood pressure. Prolonged exposure to heat or sun should be limited for several months.

Some hair around the incision may fall out, and hair regrowth may be thinner for several months. Permanent hair loss is rare but may occur. Dr. Kremer / Dr. Zettl will schedule a series of follow-up exams after your surgery. If you have a conventional forehead lift, the numbness on the top of your scalp may be replaced by itching as the nerves heal. These sensations may take as long as six months to fully disappear.

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 What is the long-term outcome like for most people?

Most people are pleased with the results of a forehead lift, no matter which surgical method was used. Many people only have one lift in a lifetime, while others have a second surgery 7-15 years later.

The results of a forehead lift are different for every individual. Remember that a forehead lift cannot stop the aging process, but your forehead will always be smoother and firmer than it would be if you hadn’t had this procedure. 

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 Ideal candidate:

In general, the best candidates for forehead lift are:

• People with good facial skin elasticity
• In good physical health
• Psychologically stable
• Non-smokers, or able to stop before and during the healing process
• Wanting to improve the appearance of furrows or frown lines on the forehead
• Well informed in regard to the procedure’s outcome
• Having realistic expectations

Note: Patients who are bald, who have a receding hairline, or who have had previous upper-eyelid surgery, may still be good candidates for forehead lift. Dr. Kremer / Dr. Zettl will simply alter the incision location or perform a more conservative operation.

The above is only a partial list of the criteria that Dr. Kremer / Dr. Zettl will consider in determining whether or not this procedure is appropriate for you. Be sure to ask Dr. Kremer / Dr. Zettl if he considers you an ideal candidate for a forehead lift.

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 Risks and limitations:

Bleeding from the cut tissues, leading to bruising and possible accumulations of blood under the skin, is unavoidable in any surgery. These problems, however, are rare. Complications are usually minor when a forehead lift is performed properly.

• Some people experience hair loss along the edges of a scar.
• A broad scar may form after surgery. Additional surgery may correct the problem.
• Loss of feeling commonly occurs along or just beyond the incision line. This is usually temporary, but may become permanent.
• Infection and bleeding are rare possibilities.
• In very rare cases, the nerves that control eyebrow movement may be injured, resulting in a loss of ability to raise the eyebrows or wrinkle the forehead.
• If a complication should occur during an endoscopic forehead lift, Dr. Kremer / Dr. Zettl may have to use the conventional, open procedure, which will result in a more extensive scar and a longer recovery period. Such complications estimated at less than 1 percent of all endoscopy procedures.

You can reduce your risk of complications by closely following Dr. Kremer / Dr. Zettl's instructions both before and after surgery.

Keep in mind that a forehead lift may improve but not eliminate the wrinkles and lines on your face. Dr. Kremer / Dr. Zettl may recommend chemical or laser resurfacing to help smooth small wrinkles over your entire face. Dr. Kremer / Dr. Zettl may also recommend injections of collagen or other substances for deep creases in your forehead or frown lines between your eyebrows. Signs of aging around the eyes, such as excess folds of eyelid skin, pockets of fat below the eyes and fine wrinkling of the eyelid skin can be improved with upper eyelid blepharoplasty or lower eyelid blepharoplasty (eyelid surgeries) which can often be performed at the same time as the forehead lift.

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 Be sure to:

• Tell Dr. Kremer / Dr. Zettl about any allergies you have (to foods, drugs, environmental elements)
• Tell Dr. Kremer / Dr. Zettl if you have a history of bad scarring, such as keloids.
• Tell Dr. Kremer / Dr. Zettl about all medications, herbal supplements or natural supplements you are taking (both prescription and non-prescription)
• Carefully follow any instructions Dr. Kremer / Dr. Zettl gives you regarding eating and drinking and smoking.
• Avoid aspirin and aspirin-containing medicines for two weeks prior to surgery.
• Arrange for someone to drive you home after surgery or after discharge from the day surgery facility or the hospital.
• Please inform Dr. Kremer / Dr. Zettl immediately in case you should experience fever or symptoms of an infection after surgery.
• Please use a cooling mask or ice packs to reduce swelling an discomfort after surgery.
• Refrain from strenuous physical activities during the first days after surgery.

The information on this web site is only intended as an introduction to this procedure and should not be used to determine whether you will have the procedure performed nor as a guarantee of the result. 

The best method of determining your personal options is to schedule a personal consultation with Dr. Kremer / Dr. Zettl. He will be able to answer specific questions related to your situation.

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