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Wrinkling across the forehead, which is the result of aging skin that is losing its elasticity, pulls down the eyebrows. Sagging eyebrows, deep grooves between the eyes, and forehead wrinkling can be corrected by a forehead or brow lift, which either tightens loose skin or removes excess skin. In some cases, it is necessary to remove part of the muscles that cause frown lines between the brows. An eyebrow lift itself, however, will not correct scars, age spots, or fine lines. The texture of the skin can be improved by accompanying procedures such as laser skin resurfacing and chemical peels and botulinum toxin injections and dermal fillers can help with wrinkles. Botulinum toxin injection temporarily paralyzes the muscle that creates wrinkles, while dermal fillers “fill in” the glabellar creases between the eyebrows.
Before surgery, we will discuss your individual skin type, ethnic background, degree of skin elasticity, healing and basic bone structure so that we may select the best method to achieve your goals.
Several techniques can be used: The coronal brow lift is the most traditional approach. The endoscopic forehead lift is the next most common variant. Less commonly, hairline, mid brow, or above the eyebrow incisions will be suggested in certain circumstances. With the coronal approach, an incision will be made from ear to ear, slightly behind the natural hairline (so the scar is not visible) along the top of the head, where a headband or headset would be worn. The scar can be well covered by wearing bangs. The incision may be made just at the hairline if it is high to avoid increasing the length of the forehead. Those with a receding hairline may prefer an incision along the natural pattern of the skull bones, mid-scalp, or above the eyebrow. The endoscopic forehead lift can be advantageous because it minimizes the incisions within the scalp and patients typically have a shorter recovery period.
Most forehead lifts are often part of a face lift so general anesthesia is very common for this procedure. For a forehead lift, the head does not need to be shaved; simply tying the hair back with a rubber band on both sides is sufficient. An incision will be made and the skin will be lifted away from the underlying tissue in order to release the muscles of the forehead and if needed, to remove excess skin or raise the eyebrows. Stitches or staples will then be used to close the incision. Gauze padding over the incision and head wrap with an elastic bandage is commonly used.
Endoscopic Brow Lift
Instead of one long incision as in the case with a coronal lift, with an endoscopic brow lift, three to five one-inch incisions in the scalp will be made. An endoscope is a small wand with a camera connected to a monitor and will be inserted after the initial incisions have been made. The endoscope is connected to a monitor and allows a clear view of the muscles and tissue underneath the skin. Through a different incision, another tool will be inserted, lift the forehead skin, and then remove or release the muscles and underlying tissues. If needed, the eyebrows will be lifted and secured in their new position with either sutures beneath the skin or with temporary screws and other methods behind the hairline. Finally, stitches or staples will be used to close up the hairline. The incisions can be dressed with gauze and elastic bandages, but is not always necessary.
Numbness and temporary pulling around the incision is common. The stitches or staples come out after about a week and temporary screws or other placeholder will be removed within two weeks. While some of the hair around the incision may thin, normal growth usually begins again within a few weeks or as long as several months.
Procedures are performed by Dr. Barry Cohen, Board Certified Plastic and Reconstructive Surgeon with great interest in cosmetic surgery. Procedures conducted in Rockville MD, and McLean, VA.