Direct forehead lift

This is a procedure undertaken using local anaesthetic to elevate the eyebrows by excising a margin of skin immediately above the eyebrow. The majority of these procedures are undertaken using only local anaesthetic which is normally tolerated very well. An ellipse of skin is excised immediately above the eyebrows. Care is taken to avoid injury to the nerve which emerges onto the forehead from eye socket, reasonably close to the midline (the supraorbital nerve) which supplies sensation to the forehead and scalp. The incision is specially angled so as not to create a bald patch above the eye brow making the incision more noticeable. The edges of the wounds are very accurately sewn together to minimise any scarring. Generally speaking, these lines of incision can be better disguised in the heavy of foreheads of males than females who fare more poorly from this procedure.

Postoperative course

The effects of the anaesthetic wear off very quickly and generally speaking, you will return home soon after surgery. The forehead is usually taped postoperatively and this maintains support while the soft tissue fixes to the forehead.

Smoking should be avoided at all costs as it worsens wound healing and increases the likelihood of most complications.

Usually, there is some discomfort on the night following surgery and this can be controlled using paracetamol (avoid aspirin).

You will be given a cooling method to hold over your forehead and orbit but the pack should not contact the skin directly.

The device fixing the skin to the forehead is frequently palpable through the skin until it dissolves within a number of months but may take up to nine months. If sutures are used, occasionally, the knots from the sutures can be felt.

Complications

The cornea of the eye can be damaged during surgery and this can lead to considerable discomfort but every effort is made to ensure that your eyes are closed and that instruments kept well clear of the eye.

Postoperative bleeding is the most common and concerning complication and this should be reported to me immediately.

Very rarely, nerves around the orbit can be injured with the major nerve of concerned being the supraorbital nerve. Less likely, the nerves supplying the muscles to your forehead can be damaged causing a paralysis.

Bruising is a normal occurrence after this procedure and can be present for 7-10 days. The amount of bruising can be minimised by using the ice packs prudently even on the day is following surgery with some effect. Avoid blood thinning agents such as aspirin and all herbal remedies pre-and post-operatively.

In cosmetic surgery it is difficult to achieve exact symmetry and if studied carefully, even in the normal person there is some difference between eyebrow positions on each side.

Infection is an uncommon but possible complication.

Postoperative scarring depending on the approach is very uncommon as the incisions are usually well concealed in the creases of the upper eyelid or by careful suturing techniques.

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