The forehead lift is usually thought of as a procedure to elevate the eyebrows but also has a dramatic effect on the upper eyelids and can even lower the hairline depending on the approach used. The forehead lift is frequently combined with a facelift although it isn’t uncommonly performed as a stand-alone procedure or in combination with eyelid surgery.
There are four basic ways to do a forehead lift. The first is called a pretrichial approach, which is a fancy way of saying in front of the hairline. This is the only procedure that actually lowers the hairline. With this approach, an incision is made just along the hairline at the top of the forehead. The forehead can then be shortened which pulls the hairline down and the eyebrows up. The incision is very well hidden after a few months since hair will grow right through the incision itself. This happens because the incision is made in a trichophytic or “hair loving” fashion. If you wear bangs, the incision is immediately hidden and after 6 months to a year, most people can pull their hair back showing off their new and youthful shortened forehead.
The second approach is called a coronal approach. This approach involves an incision about an inch or so into the hair. This allows for an excellent elevation of the brow with a nearly completely invisible scar just as soon as sutures are removed. It does however elevate the hairline, so it is not a good choice if you already have a high hairline.
The third approach is the endoscopic forehead lift. With this approach the lift is done through only a few very small incisions hidden back in the hair. This lift is less dramatic than the first two but avoids any large incisions. This approach also raises the hairline some. If only a small amount of brow elevation is desired, this is probably the best choice.
Finally the fourth approach includes the direct brow lift and the mid-forehead lift. Both of these involve incision in the forehead itself. They are meant to elevate the eyebrows only and not the entire forehead. These approaches replace creases in the forehead with incisions, which tend to look again like creases once healing is complete. They are used primarily on men who have overbearing eyebrows and not much hair on their head in which to hide incisions.
All of these procedures are done under “twilight” anesthesia. Hair is not shaved for any of the approaches. Recovery takes about two weeks at which time the bruising is typically resolved and only some mild swelling persist. There is minimal discomfort with these surgeries. An added benefit to these procedures is that at the time of surgery, the frown muscle can be removed for a permanent Botox-like effect.