Definition:

Forehead lift is the name of the surgery performed to remove wrinkles or elevate depressed eyebrows to a more desirable position. 

General Information:

The elasticity of the skin and subcutaneous tissues around the forehead, temples and eyebrows gradually disappears with aging. Horizontal wrinkles on the forehead and vertical frowning lines between the eyebrows and the sagging of the eyebrows are among the earliest signs of aging. The aim of forehead lift (eyebrow lifting) surgery is to obtain a better aesthetic appearance by removing wrinkles in the forehead area and lifting the eyebrows that have sagged downwards. This surgery can be combined with other facial rejuvenation surgeries to achieve a more harmonious and effective result.

Forehead lift can be performed under general anesthesia or local anesthesia. The choice of the type of anesthesia depends on your common decision with your doctor. Preoperative blood tests, films and electrocardiography (ECG) may be requested. These examinations will be evaluated by your doctor and anesthesiologist by taking your health condition and additional diseases into consideration. Anesthesiologist will give detailed information about general anesthesia. In forehead lift, the face shape, bone structure, hair and forehead features are evaluated together and a better appearance and function is obtained as a result of the consensus of the patient and the physician. A perfect result is never realistic. By analyzing the physical properties of the patient, the best possible result is tried to be obtained.

Planning:

After you have explained your problem to your doctor and your doctor has informed you about it in detail, you will start planning your surgery. Based on his consultation with you and his experience, your doctor may suggest additional surgeries or procedures that is considered to be aesthetically and / or functionally beneficial.

Before surgery, your face will be photographed from different sides. These photographs are important in terms of both preoperative and intraoperative planning and postoperative recording.

Operation:

Forehead lift can be performed under local anesthesia or general anesthesia according to your and your doctor’s preference. Forehead lift can be performed using different techniques. The main difference between these techniques is the location of the incisions. Usually a conventional open approach or an endoscopic approach is used. In surgery, it is mainly aimed to separate the skin of the forehead from the underlying tissues and stretch it upwards.

There are different methods to open the surgical field. The incisions are usually made in the scalp or pre-trichial. Your doctor will evaluate your forehead, face anatomy and hair structure and decide the type of incision. After the incisions, the skin around the forehead and eyebrows is separated from the underlying tissues. The skin is pulled upwards by adjusting the tension as desired and fixed in place by sutures or screws. The excess skin can be removed and the incision sites are closed.

In endoscopic surgery, several small incisions are made in the scalp. Endoscopes and other surgical instruments placed through these incisions are used to separate the forehead skin from the underlying tissues. The incisions made during endoscopic surgery are smaller; however, surgery may take longer.

In patients with very deep wrinkles on the forehead, incisions can be made to pass over the wrinkles. The operation may take one to two hours depending on the technique applied.

Expected appearance after surgery:

On the day of surgery, a head bandage is applied. On the day after surgery the head dressing is replaced with an elastic bandage. Elastic bandage is used continuously for several days; the next 1 week is only worn during sleep.

After the forehead lift, time is needed for the swelling to subside and the wound site to heal. Many patients return to work within 1 week – 10 days. The swelling and bruises that develop due to surgery will be less than you can feel at the end of this period, but not to be noticed by the people nearby. At 1 month after surgery, your recovery will be more apparent.

Forehead lift is generally considered as day-surgery, do not require hospitalization and special care; however, your doctor may want to observe you in the hospital one night.

Precautions before surgery:

• Tell your doctor if you have had any regular or irregular medications, whether you have had previous surgery or if you have an inherited disease from the family.

• Drugs such as aspirin, baby aspirin, coumadine, ibuprofen, various analgesics, and vitamin E should be discontinued a certain time before surgery. Painkillers that are safe to use will be indicated by your doctor.

• Tobacco products such as cigarettes, pipes and cigars and alcohol should be left before surgery. These substances adversely affect wound healing and surgical success by disrupting healthy blood circulation; it puts you in a higher risk group for general anesthesia.

• If you are allergic to any medicine, you must inform your doctor.

• You should inform your doctor if you are pregnant.

Day of surgery

If your surgery is in the morning, after 24:00 the night before surgery, nothing should be eaten or drunk, including water. If it will be in the afternoon, a light breakfast can be served as early as 6:00 am, provided your doctor has given you permission. If these rules are not followed, surgery may be postponed.

Regularly used drugs such as blood pressure, diabetes medication can be taken in the early morning hours with a sip of water.

• Shower can be taken in the morning. However, make-up, hair spray, gel or nail polish should not be used.

• On the day of surgery, easy-to-wear and comfortable clothes and night pajamas that can be opened from the front should be preferred. Clothes to be worn in the operating room will be provided by the hospital.

• Jewelry such as rings, necklaces, earrings should not be worn and valuable items should not be brought to the operating room.

• Materials such as contact lenses and dental prostheses and any metal objects on the body should be removed before surgery.

Postoperative recommendations

1- The head should be as high as possible and lie asleep on its back or slightly sideways as far as possible, and should not lie down.

2- It is recommended to apply cold on your forehead once every 1-2 hours and for 15-20 minutes each time; this will help improve swelling, redness and bruises faster after surgery. It is often unnecessary to continue intermittent cold application for more than 1 day.

3- Postoperative edema, swelling, asymmetrical bruises, itching and tension can be seen in the forehead and scalp. Forehead lift usually causes very little pain. This pain can be easily controlled with simple painkillers. Severe pain can be a precursor to undesirable consequences; in this case, it is recommended to see your doctor without waiting.

4- Your doctor will prescribe the pain medication you will use (usually analgesics containing paracetamol, acetaminophen or dipyrone are preferred). Aspirin or aspirin-like painkillers and other blood thinners should not be used until your doctor tells you otherwise.

5- Antibiotic and / or emollient ointments recommended by your doctor should be applied on the suture line twice a day.

6- Intensive exercise and sport should be avoided for at least 3 weeks.

7- The removal of the stitches after the operation depends on the operation, the suture material used and the healing ability of the skin. Whether or not the stitches are to be removed, the date on which it should be removed will be specified by your doctor.

Postoperative Undesirable Conditions (Complications):

THE FOREHEAD LIFT IS A SURGICAL PROCEDURE. Like all surgical interventions, this surgery has risks, including death. Some undesirable conditions that have been reported in the medical literature that may develop after forehead lift are listed below. These situations, which are not expected during a normal operation and recovery process, that cannot be predicted before the operation, but are likely to be encountered, are listed to inform you, not to intimidate you. In this way, it is aimed to have more information about the risks you may encounter after surgery. In case of an undesired situation, your doctor will inform you, take appropriate actions and refer you to other specialists if necessary.

1. Wound separation: After the stitches are removed, the corresponding wound edges on the incision line can be separated. In this case, the wound edges need to be reassembled.

2. Inflammation (infection): Inflammation (infection) may develop in and around the wound sites. Every surgical procedure is a disruption of the skin’s integrity, which is an important defense organ of the body. There is a risk of microbial contamination of the skin integrity area. Abscess may occur due to germ-trapped wound; inflammation can spread to surrounding tissues, to any other part of the body, or even to the whole, leading to death. Infection, excessive redness of the wound area, increased pain and tenderness, inflamed discharge may show symptoms. Infections that may develop can often be controlled by appropriate treatment. The risk of infection is extremely low during a forehead lift performed by a specialist physician in an appropriate environment, but it can be seen. In order to prevent infection, appropriate hygienic conditions should be provided by the patient after surgery and wound care must be taken into consideration.

3. Bleeding: As with any surgical intervention, there is a possibility of bleeding in forehead lift. Preoperative bleeding and coagulation tests will be performed. However, some rare bleeding disorders which can be seen rarely and cannot be detected by routine preoperative tests may cause excessive bleeding during or after surgery. To reduce this risk, you should tell your doctor in detail about all the medications you have been using or have used until recently; it is helpful to talk about your previous surgical or trauma experiences and, if you have any, family members with bleeding disorders.

4. Accumulation of blood at the wound site (hematoma): Postoperative blood collection under the skin (hematoma). If the hematoma develops, it may be necessary to reopen the wound and drain the accumulated blood.

5. Asymmetry: A pre-existing asymmetry in the forehead region may become more pronounced; previously absent asymmetries may develop rarely.

6. Scar (scar) and regional hair loss: After any surgical intervention, more or less, a scar remains. It is tried to ensure that the wound is healed with minimum scarring by means of storing the incisions in the scalp, passing them through the skin folds, selecting the appropriate suture materials and using the appropriate suture technique. However, normal wound healing may leave a visible scar. The incisions in the scalp may cause hair loss due to the decrease of hair follicles in this region.

7. Abnormal healing tissue (keloid) development: Some people may develop an abnormal healing tissue with pink, red or skin colored, irregular tuber-like appearance of hard, elastic consistency after skin injuries or a surgical procedure. This tissue is called keloid. In the case of keloid development, drug injections or additional surgical procedures may be required.

8. Skin color changes: In patients with darker skin, the color of the skin around the surgical site may become darker (hyperpigmentation). This change can be permanent or can maintain its presence for a long time. Thin skin, light skin, thin people may also see slight changes in skin color. In some patients, slight dandruff due to skin tension, dryness may develop.

9. Nerve Injury: The anatomical location of the nerves that enable facial muscles to work may vary in some people. Less than 1% of forehead lift have been reported to have damaged these nerves. Although the nerve varies depending on the region affected; weakness in wrinkling the forehead, weakness in the eyelids and difficulty in frowning. These damages can usually recover within a few months, but can also be permanent. In case of permanent damage, the nerve can be repaired with a number of surgeries.

10. Excessive skin folds (Dog ears): During surgery, the excess of the skin parts that create tension, usually in the curled areas may cause slight swelling. These blisters disappear over time in most patients, but they can be corrected by simple surgical procedures if not.

11. Malnutrition or necrosis of the skin: Usually heals without the need for additional surgical procedures; rarely, skin grafts may be required.

12. Pain, numbness, tingling of the skin: Sensory disorders such as tingling, diminished sensation, numbness in the scalp and the posterior areas of the incision areas can rarely be seen. These disorders are usually temporary and resolve over time.

13. Edema: Edema expected to develop after forehead lift usually lasts for 1-2 weeks. The duration of edema may vary in each patient. Prolonged, persistent swelling is usually due to underlying allergic, hormonal or circulatory problems.

14. Revision surgery: A second operation may be necessary because of overcorrection, undercorrection, or asymmetries. Additional surgical procedures and surgeries may also be required if the above-mentioned undesirable conditions are encountered.

As with almost all aesthetic surgeries, some corrective procedures may be required after forehead lift. In the event of a postoperative complication or a condition that needs to be corrected, it is usually necessary to wait 6-12 months for corrective procedures.

For corrective actions, your doctor will not charge you a processing fee. However, your doctor’s institution, operating room usage fee, bed fee, consumables used in surgery or special materials, etc. headings.

Please do not hesitate to contact your doctor if you have further questions.