Plastic surgery procedures of the forehead

Coronal lift

The initial surgery I learned to do for a forehead lift was a coronal lift. A scar was placed over the scalp extending from ear to ear, an inch or so behind the hair line. The forehead skin was lifted off the forehead, muscles removed and the skin pulled back and cut to elevate the eyebrows. The scar was just too large, and often visible. The pendulum of techniques swung the other way in the 1990s.

Endoscopic brow lift

The new technique of the 1990s required multiple small incisions, cameras, lights and TV surgery. The skin was again elevated from the hairline to the brow, muscles judiciously removed and the skin not cut but rather repositioned onto the forehead and secured in place with screws in the skull.  There are problems with this technique that I have never liked.
  • Hair loss at areas of screw placement into the skull caused too much tension concentrated into a small area
  • Drilling into the skull always seemed too aggressive for a cosmetic surgery
  • Surgery is made too complicated with too many instruments and too much time
  • Incomplete removal of the muscles of the forehead
  • High rate of recurrence and patient dissatisfaction; no skin was removed, so the extra sagging skin soon fell back into its old place
  • The exaggerated initial look of the patients was not cosmetically pleasing; the eyebrows had to be pulled up too high, giving a weird look to patients

My technique for brow lift

Over the years I have developed my own technique, which is a mixture of the two surgeries above. I now place three one-inch incisions on the forehead at the hair line, one on each side of the temples to lift the skin of the lateral brow, and one in the center of the forehead to elevate the middle of the brow. Through these incisions, I remove muscles and excess skin. Wounds are closed with fine sutures and there is no need for drilling into a patient’s skull! I think the results are great with minimal side effects, and best of all, the surgery is performed in my office under local anesthesia. I sometimes place a drain to remove unwanted fluid. Recovery takes about a week and is mainly due to swelling and bruising, which can track down to below the eyes. The cosmetic plastic surgery result is a freshened, more awake look that looks natural and raises an eyebrow in others.

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