Forehead lift

Patients who exhibit brow and eyelid aging can appear angry, sad or tired. It can be difficult to persuade some that the eyelids are not as much to blame as the descent of the brow. In fact, the brow begins to descend before the aged look to the upper eyelids begins. Normally in women, the eyebrow arches well above the ridge of the eye socket and in males, the eyebrow is flatter and positioned at the ridge of the eyebrow. The browlift is designed to lift the eyebrow to a more youthful position and in addition to appearing more youthful, it can also be functional in that it improves vision which can be impaired by heavy eyebrows. There are a number of methods by which the forehead can be lifted which are outlined below.

Transblepharoplasty forehead lift

This procedure is undertaken through an incision in the upper eyelid as for a blepharoplasty which can be undertaken under local anaesthetic as an outpatient procedure. It is aimed at elevating the lateral eyebrow which is the most likely area of the eyebrow to sag.

Local anaesthetic is infiltrated into the upper eyelid and forehead. An incision is then made into the upper eyelid and through the muscle surrounding the eyelid. Dissection is then continued over the eye socket (orbit) onto the forehead and the skin is elevated off the forehead for some distance above the orbit taking care not to damage nerves that emerge from the orbit to supply sensation to the forehead (the supraorbital nerve in particular). Sutures then used to fix the eyebrow to the forehead and temple tissue thus elevating the eyebrow. On occasion, excessive fat may also gather in the region of the upper orbit and this can be removed prudently. Usually, an upper blepharoplasty is then undertaken.

The endoscopic lift.

In the vast majority of cases, the procedure is undertaken using sedation (or a general anaesthetic) which is administered by an anaesthetist. Patients have no recollection of surgery using either method of anaesthesia.

This is a procedure undertaken for the first time in the mid-1990s and is minimally invasive compared to the procedures that preceded this. These former procedures required long incisions over the scalp which were invasive, left a considerable scar and rendered much of the scalp numb for a varying amount of time.

Up to five small incisions are placed above the hairline which does have implications for those with the male-pattern baldness. However, with careful closure these incisions can barely be detected after healing and are much less obvious than browlifts undertaken by older surgical methods. The soft tissue is elevated from the scalp and ligaments around the eyes are separated allowing the forehead to be elevated carefully with the aid of a endoscope. Similarly, the nerves supplying movement to the forehead ascending over the temple and a nerve supplying sensation to the forehead and scalp exiting from just above each orbit are carefully protected. Once all the tissue has been freed, the forehead is then elevated and repositioned by using some fixing device. There are a number of ways of achieving this.

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