With the normal aging process, the eyebrows begin to settle and add heaviness to the upper eyelids. At the same time, deep vertical wrinkles form between the brows which can give a person an “angry” look. A forehead lift, or browlift, is a surgical procedure which elevates the brows to a more youthful position. Good candidates for the forehead lift include patients with brow heaviness who are in good mental and physical health.
Dr. Caniglia’s forehead lift patients choose to have their surgery performed at the Plastic Surgery Center at Kierland (PSCK), located in the Caniglia Center in Scottsdale, Arizona. The PSCK is a fully-equipped outpatient surgery center that is accredited by the AAAHC and licensed by the state.
Most forehead lift surgeries are performed on an outpatient basis, and Dr. Caniglia prefers to use local anesthesia and intravenous sedation, also known as deep twilight sleep. Deep twilight sleep allows the patient to be pain-free during surgery and to remember nothing from surgery. This type of anesthesia also allows patients to feel more alert and refreshed after surgery. A board certified anesthesiologist is present at all times to monitor the patient’s vitals before, during, and after surgery.
While there are multiple approaches to forehead lifting surgery, one of the most common approaches is the endoscopic approach. This approach utilizes 6 small incisions, each measuring about 1 cm. in length and hidden within the hairline. For patients with very high frontal hairlines, and for those patients who want to have their hairline lowered, there is a pretrichial approach which utilizes an incision hidden at the frontal hairline. This approach can sometimes be combined with the endoscopic approach. An older, rarely utilized technique is the coronal approach which involves an incision placed back in the hairline from ear to ear. The major downside to this approach is that it will move the frontal hairline back about an inch, giving the patient a taller forehead. Other approaches which are rarely used today include the mid forehead lift and the direct brow lift.
With the endoscopic approach, after the six 1-cm. incisions are made within the hairline, the skin of the forehead is then elevated away from the bone, down to the supraorbital rim, or eye socket. This is performed with the aid of an endoscope, a small scope which is attached to a TV monitor. The most important part of a forehead lift is the release of the muscles and periosteum (the clear fibrous lining that attaches the brows to the bone). Without proper release, the brows will not come up. A laser is used to release these muscles and the periosteum as it is very precise. Furthermore, the laser results in very little bleeding which, in turn, results in very little postoperative bruising. Once the muscles and periosteum are released, the brows are elevated to their new, more youthful position. This is where a skilled surgeon with a keen aesthetic eye is essential to a good outcome. Once the brows have been elevated to their new position, they are fixated internally, under the scalp, with dissolvable sutures and small 4mm dissolvable posts. All incisions in the hairline are then closed. A light gauze pressure wrap is placed on the forehead and the patient is moved to the recovery room.
All forehead lifts are performed on an outpatient basis, allowing patients to return home the same day. Patients return to the office on the day after their surgery to have their gauze dressing removed. There are no further dressings or drains used. The patient is allowed to shampoo the hair on the day after surgery, and all sutures are removed on day 7. Most patients are able to return to work after one week. However, if one has more bruising than the average patient, this may require an additional day or two of recovery. Dr. Caniglia asks all patients to refrain from heavy, strenuous activity and exercise for two weeks after the forehead lift.
With the forehead lift, major risks and complications are fortunately very rare, especially when the endoscopic approach is used. Some of the risks include hematoma, hair loss, numbness and nerve paralysis. A qualified, experienced facial plastic surgeon can help to minimize your risk while providing you with a beautiful, successful result.