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Forehead Lift

INTRODUCTION

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.

PROCEDURE DESCRIPTION

There are four main ways of rejuvenating the forehead:

Botox with Upper Lid Blepharoplasty
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. In this procedure, Boxtox is administered to the forehead muscles and between the eyes, coupled with an upper eyelid lift. 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.

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.

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.

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.

Advantages

• 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

• 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
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 surgery center 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
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 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.

Nerve Injury
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.

Hair Loss
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.

Smoking
Smoking is an absolute contraindication for forehead lift. The carbon monoxide and nicotine in cigarette smoke causes severe reduction in blood supply to the skin and scalp during healing. This results in delayed wound healing, wound separation, death of the skin, and a higher risk of infection. Cotinine testing is performed in patients with a smoking history to ensure that they are safe when having this procedure.

RECOVERY

Our office will provide a comprehensive post-operative plan to ensure the best possible outcome. The plan will include what to expect postoperatively, such as estimated recovery time, pain management, garments or dressings, and anticipated activity level. For your safety, we require that an adult stay with you at least the first 24 hours after surgery and drives you to your next day follow-up visit. With most facial procedures, you will be instructed to limit activity for the first week or two, which could include restrictions on driving, prolonged travel and flying. In addition, we ask you refrain from exercise until cleared by the physician, usually around four weeks post-op. You are asked to refrain from smoking for a minimum of two weeks. To optimize healing, we recommend that you eat a high protein diet. You should anticipate a variable degree of bruising and swelling, as with any surgical procedure; light make-up may be used to cover bruises starting a week after surgery. We also offer scar creams at an additional cost to optimize results.

To promote healing and minimize complications, you will be seen in a series of post-op appointments, including the day after surgery. These appointments will continue throughout the first year after the procedure to make sure you are healing as planned. For your added convenience, you also have direct access to Dr. Bitar’s cell phone number if you need to reach him after hours. The final post-op visit, one year after surgery, is one of our favorites since the results are fully apparent and we love seeing our patients happy. You are always welcome to come back and see us, even years after your surgery.

MAXIMIZING POSITIVE OUTCOMES

At the Bitar Cosmetic Surgery Institute, we take pride in providing our patients with the best surgical experience possible, emphasizing patient safety while trying to optimize surgical results. This is a process that includes comprehensive pre-operative preparation and patient education, the development of a personalized operative plan, and a thoughtful post operative care regimen emphasizing patient comfort and promoting recovery.

There are a number of strategies which the Institute has adapted to further ensure patient safety. We are selective and only offer surgery to patients whose general health and lifestyle choices permit healing and facilitate recovery. To minimize risk, we require a preoperative assessment that includes a thoughtful history and physical exam, as well as targeted laboratory tests.

We operate at accredited hospitals and surgicenters that have demonstrated a commitment to the highest standards of care, employing board certified anesthesiologists and nurses. We adhere to well established surgical principles designed to ensure patient safety and have developed policies and protocols to minimize the risk of infection. Dr. Bitar is committed to continuing education, honing his skills and introducing new techniques always with the aim of improving safety and surgical results.

We emphasize patient safety in our peri-operative care plan, advocating early mobilization, optimizing nutrition, and providing detailed care instructions. After surgery, patients are seen in our office frequently and early, starting the day after their procedure, and a staff member is available around the clock for any questions or concerns. Our entire team is committed to our patients’ well being and every measure is designed to minimize potential complications, promote comfortable and rapid recovery, and optimize surgical results.

WHY CHOOSE BITAR COSMETIC SURGERY INSTITUTE?

Our commitment to excellence and exceptional patient care is in every step of your doctor-patient experience. Dr. George Bitar is a distinguished board certified plastic surgeon who stays on the cutting edge of advancements in cosmetic surgery and technology to offer the best possible results. With a blend of artistry and meticulous surgical technique, he is able to achieve beautiful and natural results for our patients. We provide a high level of patient safety and our experienced and caring staff will be with you every step of the way. Our institute offers a wide variety of surgical and non-surgical options, from skin care, injectables and lasers to in-office or hospital options, to provide a versatile approach to fit individual patient needs. Your aesthetic goals are our priority and each procedure is customized to ensure you receive the best possible outcome.

For more information, call our office at 703-206-0506.

Content on this website is for information only and should not be used to diagnose or treat your plastic surgery or cosmetic surgery problems. Please contact your plastic surgeon with all questions and concerns.